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Resuscitation. 2019 Mar;136:119-125. doi: 10.1016/j.resuscitation.2019.01.021. Epub 2019 Jan 29.

The effect of intravenous adrenaline on electrocardiographic changes during resuscitation in patients with initial pulseless electrical activity in out of hospital cardiac arrest.

Author information

1
Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Department of Anesthesiology, Nordland Hospital, Bodø, Norway. Electronic address: gunnar.w.skjeflo@ntnu.no.
2
Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; St. Olavs Hospital, Trondheim University Hospital, Department of Anesthesia and Intensive Care Medicine, Trondheim, Norway.
3
Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; St. Olavs Hospital, Trondheim University Hospital, Department of Cardiology, Trondheim, Norway.
4
Department of Anesthesiology, Oslo University Hospital, Oslo, Norway.
5
Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo University Hospital, Oslo, Norway.
6
Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; St Olavs Hospital, Trondheim University Hospital, Department of Emergency Medicine and Pre-Hospital Services, Trondheim, Norway.

Abstract

INTRODUCTION:

Presence of electrocardiographic rhythm in the absence of palpable pulses defines pulseless electrical activity (PEA) and the electrocardiogram (ECG) may provide a source of information during resuscitation. The aim of this study was to examine the development of ECG characteristics during advanced life support (ALS) from Out-of-hospital cardiac arrest (OHCA) with initial PEA, and to explore the potential effects of adrenaline on these characteristics.

METHODS:

Patients with OHCA and initial PEA, part of randomized controlled trial of ALS with or without intravenous access and medications, were included. A total of 4840 combined observations of QRS complex rate (heart rate) and width were made by examining defibrillator recordings from 170 episodes of cardiac arrest.

RESULTS:

We found Increased heart rate (47 beats per minute) and reduced QRS complex width (62 ms) during ALS in patients who obtained return of spontaneous circulation (ROSC); while patients who received adrenaline but died increased their heart rate (22 beats per minute) without any concomitant decrease in QRS complex width.

CONCLUSION:

ECG changes during ALS in cardiac arrest were associated with prognosis, and the administration of adrenaline impacted on these changes.

KEYWORDS:

Adrenaline; Advanced life support; Cardiac arrest; ECG; Electrocardiographic; Epinephrine; PEA; Pulseless electrical activity

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