Association between postresuscitation 12-lead ECG features and long-term neurological outcome after out-of-hospital cardiac arrest: a post-hoc subanalysis of the PEACE study

Background

Out-of-hospital cardiac arrest (OHCA) has low survival rates worldwide. For the diagnosis of acute coronary syndrome causing OHCA and the identification of patients eligible for immediate coronary angiography, the post-return of spontaneous circulation electrocardiogram (post-ROSC ECG) is crucial. However, it is still unclear whether post-ROSC ECG features also pose a sensible feature for outcome prediction.

Methods

This retrospective study analysed adult non-traumatic OHCA cases with post-ROSC ECGs admitted to one of the three participating centers in Vienna (Austria), Pavia (Italy) and Lugano (Switzerland) between 01/2015 and 12/2018, and reports ECG features, survival and neurological outcome (at hospital discharge and after one year). Univariable and multivariable logistic regression assessed associations between ECG features and neurological outcome.

Results

STEMI was diagnosed in 53.5% of post-ROSC ECGs. 68.1% of patients were discharged, with 59.5% having a favorable neurological outcome. One year later, 61.6% of non-STEMI patients had a favorable outcome compared to 54% of STEMI patients. Univariable analysis indicated that ST-elevations in II, III, and aVF, as well as a broader QRS complex significantly influenced neurological outcomes at one year.

Conclusions

ECG after ROSC can identify patients at high risk of death after OHCA earlier than other prognostic methods, not only in terms of short-term mortality, but also in terms of neurological outcome one year after OHCA. Wider QRS complex and ST-elevations in II, III, or aVF were identified as specific prognosticators.