Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May 16;12(10):e027923.
doi: 10.1161/JAHA.122.027923. Epub 2023 May 15.

Association Between Postresuscitation 12-Lead ECG Features and Early Mortality After Out-of-Hospital Cardiac Arrest: A Post Hoc Subanalysis of the PEACE Study

Francesca Romana Gentile  1   2 , Enrico Baldi  1   2 , Catherine Klersy  3 , Sebastian Schnaubelt  4 , Maria Luce Caputo  5 , Christian Clodi  4 , Jolie Bruno  5 , Sara Compagnoni  1   2 , Alessandro Fasolino  1   2 , Claudio Benvenuti  6 , Hans Domanovits  3 , Roman Burkart  6 , Roberto Primi  7 , Gerhard Ruzicka  4 , Michael Holzer  4 , Angelo Auricchio  5 , Simone Savastano  7
Affiliations

Association Between Postresuscitation 12-Lead ECG Features and Early Mortality After Out-of-Hospital Cardiac Arrest: A Post Hoc Subanalysis of the PEACE Study

Francesca Romana Gentile et al. J Am Heart Assoc. .

Abstract

Background Once the return of spontaneous circulation after out-of-hospital cardiac arrest is achieved, a 12-lead ECG is strongly recommended to identify candidates for urgent coronary angiography. ECG has no apparent role in mortality risk stratification. We aimed to assess whether ECG features could be associated with 30-day survival in patients with out-of-hospital cardiac arrest. Methods and Results All the post-return of spontaneous circulation ECGs from January 2015 to December 2018 in 3 European centers (Pavia, Lugano, and Vienna) were collected. Prehospital data were collected according to the Utstein style. A total of 370 ECGs were collected: 287 men (77.6%) with a median age of 62 years (interquartile range, 53-70 years). After correction for the return of spontaneous circulation-to-ECG time, age >62 years (hazard ratio [HR], 1.78 [95% CI, 1.21-2.61]; P=0.003), female sex (HR, 1.5 [95% CI, 1.05-2.13]; P=0.025), QRS wider than 120 ms (HR, 1.64 [95% CI, 1.43-1.87]; P<0.001), the presence of a Brugada pattern (HR, 1.49 [95% CI, 1.39-1.59]; P<0.001), and the presence of ST-segment elevation in >1 segment (HR, 1.75 [95% CI, 1.59-1.93]; P<0.001) were independently associated with 30-day mortality. A score ranging from 0 to 26 was created, and by dividing the population into 3 tertiles, 3 classes of risk were found with significantly different survival rate at 30 days (score 0-4, 73%; score 5-7, 66%; score 8-26, 45%). Conclusions The post-return of spontaneous circulation ECG can identify patients who are at high risk of mortality after out-of-hospital cardiac arrest earlier than other forms of prognostication. This provides important risk stratification possibilities in postcardiac arrest care that could help to direct treatments and improve outcomes in patients with out-of-hospital cardiac arrest.

Keywords: ECG; cardiac arrest; post‐ROSC care.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Flowchart of the study participants.
ROSC indicates return of spontaneous circulation.
Figure 2
Figure 2. Plot of the predicted HR for 1‐unit increase in the score.
HRs and 95% CI with respect to score 1 is tabulated to the left of the figure and plotted to the right in function of the score. HR indicates hazard ratio.
Figure 3
Figure 3. Kaplan–Meier survival estimates of survival (Cox P value <0.001).
There was a significant difference among all groups (P<0.001).
Figure 4
Figure 4. Rate of death per 100 person‐week according to groups of risk in cardiac and noncardiac causes.
See this image and copyright information in PMC

References

    1. Kiguchi T, Okubo M, Nishiyama C, Maconochie I, Ong MEH, Kern KB, Wyckoff MH, McNally B, Christensen EF, Tjelmeland I, et al. Out‐of‐hospital cardiac arrest across the world: first report from the International Liaison Committee on Resuscitation (ILCOR). Resuscitation. 2020;152:39–49. doi: 10.1016/j.resuscitation.2020.02.044 - DOI - PubMed
    1. McNally B, Robb R, Mehta M, Vellano K, Valderrama AL, Yoon PW, Sasson C, Crouch A, Perez AB, Merritt M, et al. Out‐of‐hospital cardiac arrest surveillance—Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005—December 31, 2010. MMWR Surveill Summ. 2011;60:1–19. - PubMed
    1. Baldi E, Caputo ML, Savastano S, Burkart R, Klersy C, Benvenuti C, Sgromo V, Palo A, Cianella R, Cacciatore E, et al. An Utstein‐based model score to predict survival to hospital admission: the UB‐ROSC score. Int J Cardiol. 2020;308:84–89. doi: 10.1016/j.ijcard.2020.01.032 - DOI - PubMed
    1. Maupain C, Bougouin W, Lamhaut L, Deye N, Diehl JL, Geri G, Perier MC, Beganton F, Marijon E, Jouven X, et al. The CAHP (Cardiac Arrest Hospital Prognosis) score: a tool for risk stratification after out‐of‐hospital cardiac arrest. Eur Heart J. 2016;37:3222–3228. doi: 10.1093/eurheartj/ehv556 - DOI - PubMed
    1. Lemiale V, Dumas F, Mongardon N, Giovanetti O, Charpentier J, Chiche JD, Carli P, Mira JP, Nolan J, Cariou A. Intensive care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort. Intensive Care Med. 2013;39:1972–1980. doi: 10.1007/s00134-013-3043-4 - DOI - PubMed

Publication types