Pulseless electrical activity and asystole during in-hospital cardiac arrest: Disentangling the 'nonshockable' rhythms.
Cardiac arrest
Cardiac rhythm
Resuscitation
Journal
Resuscitation
ISSN: 1873-1570
Titre abrégé: Resuscitation
Pays: Ireland
ID NLM: 0332173
Informations de publication
Date de publication:
08 2023
08 2023
Historique:
received:
07
04
2023
revised:
23
05
2023
accepted:
25
05
2023
pmc-release:
01
08
2024
medline:
26
7
2023
pubmed:
4
6
2023
entrez:
3
6
2023
Statut:
ppublish
Résumé
Pulseless electrical activity (PEA) and asystole account for 81% of initial in-hospital cardiac arrest (IHCA) rhythms in the U.S.A. These "non-shockable" rhythms are often grouped together in resuscitation research and practice. We hypothesized that PEA and asystole are distinct initial IHCA rhythms with distinguishing features. This was an observational cohort study using the prospectively collected nationwide Get With The Guidelines®-Resuscitation registry. Adult patients with an index IHCA and an initial rhythm of PEA or asystole between the years of 2006 and 2019 were included. Patients with PEA vs. asystole were compared with respect to pre-arrest characteristics, resuscitation practice, and outcomes. We identified 147,377 (64.9%) PEA and 79,720 (35.1%) asystolic IHCA. Asystole had more arrests in non-telemetry wards (20,530/147,377 [13.9%] PEA vs. 17,618/79,720 [22.1%] asystole). Asystole had 3% lower adjusted odds of ROSC (91,007 [61.8%] PEA vs. 44,957 [56.4%] asystole, aOR 0.97, 95%CI 0.96-0.97, P < 0.01); there was no statistically significant difference in survival to discharge (28,075 [19.1%] PEA vs. 14,891 [18.7%] asystole, aOR 1.00, 95%CI 1.00-1.01, P = 0.63). Duration of resuscitation for those without ROSC were shorter for asystole (29.8 [±22.5] minutes in PEA vs. 26.2 [±21.5] minutes in asystole, adjusted mean difference -3.05 95%CI -3.36--2.74, P < 0.01). Patients suffering IHCA with an initial PEA rhythm had patient and resuscitation level differences from those with asystole. PEA arrests were more common in monitored settings and received longer resuscitations. Even though PEA was associated with higher rates of ROSC, there was no difference in survival to discharge.
Sections du résumé
BACKGROUND
Pulseless electrical activity (PEA) and asystole account for 81% of initial in-hospital cardiac arrest (IHCA) rhythms in the U.S.A. These "non-shockable" rhythms are often grouped together in resuscitation research and practice. We hypothesized that PEA and asystole are distinct initial IHCA rhythms with distinguishing features.
METHODS
This was an observational cohort study using the prospectively collected nationwide Get With The Guidelines®-Resuscitation registry. Adult patients with an index IHCA and an initial rhythm of PEA or asystole between the years of 2006 and 2019 were included. Patients with PEA vs. asystole were compared with respect to pre-arrest characteristics, resuscitation practice, and outcomes.
RESULTS
We identified 147,377 (64.9%) PEA and 79,720 (35.1%) asystolic IHCA. Asystole had more arrests in non-telemetry wards (20,530/147,377 [13.9%] PEA vs. 17,618/79,720 [22.1%] asystole). Asystole had 3% lower adjusted odds of ROSC (91,007 [61.8%] PEA vs. 44,957 [56.4%] asystole, aOR 0.97, 95%CI 0.96-0.97, P < 0.01); there was no statistically significant difference in survival to discharge (28,075 [19.1%] PEA vs. 14,891 [18.7%] asystole, aOR 1.00, 95%CI 1.00-1.01, P = 0.63). Duration of resuscitation for those without ROSC were shorter for asystole (29.8 [±22.5] minutes in PEA vs. 26.2 [±21.5] minutes in asystole, adjusted mean difference -3.05 95%CI -3.36--2.74, P < 0.01).
INTERPRETATION
Patients suffering IHCA with an initial PEA rhythm had patient and resuscitation level differences from those with asystole. PEA arrests were more common in monitored settings and received longer resuscitations. Even though PEA was associated with higher rates of ROSC, there was no difference in survival to discharge.
Identifiants
pubmed: 37270088
pii: S0300-9572(23)00170-3
doi: 10.1016/j.resuscitation.2023.109857
pmc: PMC10527285
mid: NIHMS1911966
pii:
doi:
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
109857Subventions
Organisme : NHLBI NIH HHS
ID : R61 HL162980
Pays : United States
Informations de copyright
Copyright © 2023 Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Références
Lancet. 2012 Oct 27;380(9852):1473-81
pubmed: 22958912
Prehosp Emerg Care. 2014 Apr-Jun;18(2):224-30
pubmed: 24400944
JAMA. 2006 Jan 4;295(1):50-7
pubmed: 16391216
Resuscitation. 2016 Nov;108:40-47
pubmed: 27616581
N Engl J Med. 2021 Jun 17;384(24):2283-2294
pubmed: 34133859
Resuscitation. 2015 Oct;95:100-47
pubmed: 26477701
Intensive Care Med. 2007 Feb;33(2):237-45
pubmed: 17019558
Resuscitation. 2021 Aug;165:50-57
pubmed: 34126134
Resuscitation. 2021 Jan;158:166-174
pubmed: 33248155
Resuscitation. 2014 Nov;85(11):1633-9
pubmed: 25110246
JAMA. 2019 Mar 26;321(12):1200-1210
pubmed: 30912843
Resuscitation. 2000 Mar;44(1):7-17
pubmed: 10699695
Circulation. 2020 Oct 20;142(16_suppl_2):S366-S468
pubmed: 33081529
Resuscitation. 2018 Dec;133:147-152
pubmed: 30352246
N Engl J Med. 2013 Dec 5;369(23):2197-206
pubmed: 24237006
N Engl J Med. 2012 Nov 15;367(20):1912-20
pubmed: 23150959
Crit Care Med. 2010 Jan;38(1):101-8
pubmed: 19770741
Resuscitation. 2014 Aug;85(8):987-92
pubmed: 24746785
N Engl J Med. 2004 Jan 8;350(2):105-13
pubmed: 14711909
Resuscitation. 2020 Feb 1;147:1-11
pubmed: 31846693
JAMA. 2002 Dec 18;288(23):3008-13
pubmed: 12479765
Resuscitation. 2018 Apr;125:79-82
pubmed: 29425975
Resuscitation. 2003 Sep;58(3):297-308
pubmed: 12969608
Circulation. 2018 Mar 20;137(12):e67-e492
pubmed: 29386200
N Engl J Med. 2021 Dec 30;385(27):2544-2553
pubmed: 34459570