Heart rate and QRS duration as biomarkers predict the immediate outcome from pulseless electrical activity

Introduction Pulseless electrical activity (PEA) is commonly observed in in-hospital cardiac arrest (IHCA). Universally available ECG characteristics such as QRS duration (QRSd) and heart rate (HR) may develop differently in patients who obtain ROSC or not. The aim of this study was to assess prospectively how QRSd and HR as biomarkers predict the immediate outcome of patients with PEA. Method We investigated 327 episodes of IHCA in 298 patients at two US and one Norwegian hospital. We assessed the ECG in 559 segments of PEA nested within episodes, measuring QRSd and HR during pauses of compressions, and noted the clinical state that immediately followed PEA. We investigated the development of HR, QRSd, and transitions to ROSC or no-ROSC (VF/VT, asystole or death) in a joint longitudinal and competing risks statistical model. Results Higher HR, and a rising HR, reflect a higher transition intensity (“hazard”) to ROSC (p < 0.001), but HR was not associated with the transition intensity to no-ROSC. A lower QRSd and a shrinking QRSd reflect an increased transition intensity to ROSC (p = 0.023) and a reduced transition intensity to no-ROSC (p = 0.002). Conclusion HR and QRSd convey information of the immediate outcome during resuscitation from PEA. These universally available and promising biomarkers may guide the emergency team in tailoring individual treatment.publishedVersio

Ectopic pregnancy- etiology, modern diagnostic and therapeutic approach

Ectopic pregnancy can be a life-threatening condition occurring in women all over the world. Over the past decades there has been a fluctuation in the incidence of the condition. This can be explained by factors like changing incidence of PID in the population, changing habits in contraceptive (IUD) use and increased diagnostic abilities. The clinical picture of ectopic pregnancy can be very individual and the doctor must therefore always have a high suspicion towards the diagnosis in a fertile woman, independent of symptoms. The presenting signs and symptoms range from a completely asymptomatic woman to a woman presenting with an acute abdomen and shock. The symptoms most commonly reported are abdominal pain, vaginal bleeding or spotting and amenorrhoea can also be present. The cornerstones in the diagnosis, together with history and physical examination, are ultrasound and hCG levels in serum. Despite the big progress in diagnosing the condition there can be cases where the physician will feel unsure about the diagnosis. Complication that we fear the most is rupture. It can lead to death. Since this is a outcome we don't want, it is necessary to increase the awareness among doctors and nurses and always think of the condition when presented with a woman in her fertile age

Ectopic pregnancy- etiology, modern diagnostic and therapeutic approach

Ectopic pregnancy can be a life-threatening condition occurring in women all over the world. Over the past decades there has been a fluctuation in the incidence of the condition. This can be explained by factors like changing incidence of PID in the population, changing habits in contraceptive (IUD) use and increased diagnostic abilities. The clinical picture of ectopic pregnancy can be very individual and the doctor must therefore always have a high suspicion towards the diagnosis in a fertile woman, independent of symptoms. The presenting signs and symptoms range from a completely asymptomatic woman to a woman presenting with an acute abdomen and shock. The symptoms most commonly reported are abdominal pain, vaginal bleeding or spotting and amenorrhoea can also be present. The cornerstones in the diagnosis, together with history and physical examination, are ultrasound and hCG levels in serum. Despite the big progress in diagnosing the condition there can be cases where the physician will feel unsure about the diagnosis. Complication that we fear the most is rupture. It can lead to death. Since this is a outcome we don't want, it is necessary to increase the awareness among doctors and nurses and always think of the condition when presented with a woman in her fertile age

Machine learning model to predict evolution of pulseless electrical activity during in-hospital cardiac arrest.

BACKGROUND: During pulseless electrical activity (PEA) the cardiac mechanical and electrical functions are dissociated, a phenomenon occurring in 25-42% of in-hospital cardiac arrest (IHCA) cases. Accurate evaluation of the likelihood of a PEA patient transitioning to return of spontaneous circulation (ROSC) may be vital for the successful resuscitation. THE AIM: We sought to develop a model to automatically discriminate between PEA rhythms with favorable and unfavorable evolution to ROSC. METHODS: A dataset of 190 patients, 120 with ROSC, were acquired with defibrillators from different vendors in three hospitals. The ECG and the transthoracic impedance (TTI) signal were processed to compute 16 waveform features. Logistic regression models where designed integrating both automated features and characteristics annotated in the QRS to identify PEAs with better prognosis leading to ROSC. Cross validation techniques were applied, both patient-specific and stratified, to evaluate the performance of the algorithm. RESULTS: The best model consisted in a three feature algorithm that exhibited median (interquartile range) Area Under the Curve/Balanced accuracy/Sensitivity/Specificity of 80.3(9.9)/75.6(8.0)/ 77.4(15.2)/72.3(16.4) %, respectively. CONCLUSIONS: Information hidden in the waveforms of the ECG and TTI signals, along with QRS complex features, can predict the progression of PEA. Automated methods as the one proposed in this study, could contribute to assist in the targeted treatment of PEA in IHCA