Newswise — Annually, approximately 1,200 to 1,500 individuals encounter a cardiac arrest within Norwegian medical facilities. Swift and effective intervention is utterly crucial for ensuring the survival of these patients.
Despite the occurrence of a cardiac arrest within the confines of the hospital, the outlook remains bleak. Merely one out of every four patients manages to survive.
Nonetheless, recent research proposes that readily accessible information obtained from the patient's own electrocardiogram (ECG) has the potential to alter the outcome.
Treatment the same for everyone
When a cardiac arrest occurs, physicians must act swiftly, and the life-saving endeavor can endure for a significant duration.
But doctors rarely have a good idea of what the outcome will be.
"Anders Norvik, a senior consultant at St. Olavs Hospital in Trondheim, Norway, and a PhD candidate at the Norwegian University of Science and Technology (NTNU), expressed, 'Presently, all patients receive identical treatment. Considering the diverse array of cardiac arrest types and patient characteristics, we believe this approach lacks logical reasoning.'"
Norvik, together with researchers from Trondheim, Stavanger, the USA, and Spain, embarked on a quest to discover a solution to this predicament.
In their recent study, the team scrutinized electrocardiogram (ECG) data obtained from 298 patients who experienced cardiac arrest. The data was collected from defibrillators used at St. Olavs Hospital in Trondheim and two hospitals in the United States.
"Eirik Skogvoll, an NTNU professor and senior consultant in pediatric anesthesia at St. Olavs Hospital, explains the rationale behind choosing ECG as the method, stating, 'We opted for ECG as the modality because all cardiac arrest patients are connected to an ECG monitor with electrodes. The ECG monitor is either integrated into the defibrillator carried by the ambulance or emergency team, or it is part of a separate monitoring system within the hospital. In other words, the ECG is consistently accessible and serves as a universal source of information.'"
Initially, the researchers analyzed the data by closely observing the progress of each individual patient and determining whether their pulse spontaneously returned as a result of the treatment administered. Subsequently, they examined the ECG recordings taken immediately before the patient's heart rate experienced a change.
Skogvoll elaborates, "Surprisingly, we observed that there is an elevated heart rate just before the patient's pulse is restored compared to cases where the pulse does not return. This discovery provides us with the opportunity for an ongoing prognostic assessment—a sort of weather forecast indicating favorable or unfavorable outcomes."
Additionally, the researchers utilized another piece of information derived from the ECG—specifically, the width of the ECG signal. A narrow or tapering signal width was identified as a positive indication, whereas a broad or spreading signal width was deemed less favorable.
Tailored treatment the goal
The hope is that the new method can allow for more tailored treatments in the future.
Skogvoll, the lead researcher, explains, "If the ECG results align with a positive direction, it could signify that we should persist with the effective treatment being administered. Conversely, if the ECG results indicate an unfavorable direction, it may necessitate reevaluating certain aspects of the treatment strategy."
“This could be a way to individualize cardiac arrest treatment,” he said.
The international research group is the first ever to quantify this connection.
However, the medical professionals at St. Olav Hospital maintain that further research is imperative to attain more comprehensive answers. They emphasize the significance of verifying the findings through additional independent studies to ensure their validity and reliability.
“We hope this can help save more lives,” Norvik said.
The doctors emphasized that even when a cardiac arrest occurs within a hospital setting, the chances of survival remain at a mere 25 percent.
If you were to witness a cardiac arrest, Norvik and his colleagues have some good advice.
"Two crucial steps must be taken in such situations," Norvik explained. "Firstly, promptly summon help, and secondly, initiate CPR by administering 30 cardiac compressions followed by two breaths. This cycle should be continued until assistance arrives or a defibrillator is brought in," Norvik advised.
Indeed, for an individual to survive a cardiac arrest, it is essential that someone witnesses the event and takes immediate action. Quick recognition of the situation and proactive intervention are crucial factors in increasing the chances of survival.
Reference: . Norvik, J.T. Kvaløy, GW. Skjeflo, D. Bergum, T. Nordseth, J.P. Loennechen, E. Unneland, D.G. Buckler, A. Bhardwaj, T. Eftestøl, E. Aramendi, BS. Abella, E. Skogvoll. Heart rate and QRS duration as biomarkers predict the immediate outcome from pulseless electrical activity. Resuscitation, Vol. 185, 2023.
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