QRS complex findings in patients following out-of-hospital cardiac arrest with particular focus on their coronary statusMartin Christ, Katharina Isabel von Auenmueller, Wolfgang Dierschke, Michael Brand, Thomas Butz, Martin Grett, Hans-Joachim Trappe.
Background: There is still a lack of knowledge about the clinical relevance of electrocardiographic findings in patients
following out-of-hospital cardiac arrest (OHCA). Methods: All victims of OHCA who were admitted to our hospital
between January 1st 2008 and December 31st 2013 were identified and their QRS complexes were analyzed according
to QRS duration and QRS morphology measured with the simplified Selvester Score. Results: A total of 147 out of 204
OHCA patients were included in our study, of which 76 received coronary angiography. The first 12-lead ECG showed
a mean QRS duration of 108.0 ± 22.1 ms and 4.3 ± 3.5 points for the simplified Selvester Score. QRS complexes in
patients following OHCA due to an initial shockable rhythm were significantly wider in patients who were discharged
alive (114.0 ± 23.8 ms) than in patients who died in-hospital (98.9 ± 18.1 ms) (p=0.016), and patients who survived until
the follow-up examination showed a significant reduction in the QRS duration (p=0.001), whereas the simplified Selvester
Score showed no such changes. Subgroup analyses revealed that this reduction in QRS duration was most pronounced in
patients with coronary artery disease (CAD) who received percutaneous coronary intervention (PCI). Conclusion: Neither
QRS duration nor QRS morphology can reliably predict the prognosis of all patients following OHCA. However, as QRS
durations decrease, especially in patients with CAD who receive PCI, it is possible that standardized QRS monitoring in
patients following OHCA could be a useful tool in the monitoring of the hemodynamics of patients following OHCA.
Key words: out-of-hospital cardiac arrest, QRS duration, QRS morphology, simplified Selvester Score, post-resuscitation
treatment, coronary artery disease.