Attin Mina, Feld Gregory, Lemus Hector, Najarian Kayvan, Shandilya Sharad, Wang Lu, Sabouriazad Pouya, Lin Chii-Dean
School of Nursing, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA,
J Clin Monit Comput. 2015 Jun;29(3):385-92. doi: 10.1007/s10877-014-9616-0. Epub 2014 Sep 19.
Survival after in-hospital cardiac arrest (I-HCA) remains < 30 %. There is very limited literature exploring the electrocardiogram changes prior to I-HCA. The purpose of the study was to determine demographics and electrocardiographic predictors prior to I-HCA. A retrospective study was conducted among 39 cardiovascular subjects who had cardiopulmonary resuscitation from I-HCA with initial rhythms of pulseless electrical activity (PEA) and asystole. Demographics including medical history, ejection fraction, laboratory values, and medications were examined. Electrocardiogram (ECG) parameters from telemetry were studied to identify changes in heart rate, QRS duration and morphology, and time of occurrence and location of ST segment changes prior to I-HCA. Increased age was significantly associated with failure to survive to discharge (p < 0.05). Significant change was observed in heart rate including a downtrend of heart rate within 15 min prior to I-HCA (p < 0.05). There was a significant difference in heart rate and QRS duration during the last hour prior to I-HCA compared to the previous hours (p < 0.05). Inferior ECG leads showed the most significant changes in QRS morphology and ST segments prior to I-HCA (p < 0.05). Subjects with an initial rhythm of asystole demonstrated significantly greater ECG changes including QRS morphology and ST segment changes compared to the subjects with initial rhythms of PEA (p < 0.05). Diagnostic ECG trends can be identified prior to I-HCA due to PEA and asystole and can be further utilized for training a predictive machine learning model for I-HCA.
院内心脏骤停（I-HCA）后的生存率仍低于30%。探索I-HCA之前心电图变化的文献非常有限。本研究的目的是确定I-HCA之前的人口统计学特征和心电图预测因素。对39名因I-HCA接受心肺复苏且初始心律为无脉电活动（PEA）和心搏停止的心血管疾病患者进行了一项回顾性研究。检查了包括病史、射血分数、实验室检查值和用药情况在内的人口统计学特征。研究了遥测心电图（ECG）参数，以确定I-HCA之前心率、QRS波时限和形态的变化，以及ST段变化的发生时间和位置。年龄增加与未能存活至出院显著相关（p<0.05）。观察到心率有显著变化，包括I-HCA前15分钟内心率呈下降趋势（p<0.05）。与前几个小时相比，I-HCA前最后一小时的心率和QRS波时限有显著差异（p<0.05）。I-HCA之前，心电图下壁导联的QRS波形态和ST段变化最为显著（p<0.05）。与初始心律为PEA的患者相比，初始心律为心搏停止的患者的心电图变化（包括QRS波形态和ST段变化）显著更大（p<0.05）。由于PEA和心搏停止，在I-HCA之前可以识别出诊断性心电图趋势，并且可以进一步用于训练I-HCA的预测性机器学习模型。
