Peripheral perfusion index and diagnostic accuracy of the post-ROSC electrocardiogram in patients with medical out-of-hospital cardiac arrest

Compagnoni, Sara; Gentile, Francesca Romana; Baldi, Enrico; Contri, Enrico; Palo, Alessandra; Primi, Roberto; Currao, A; Bendotti, S; Ziliani, Paola; Ormezzano, Maurizio Ferrario; Visconti, Luigi Oltrona; Savastano, Simone

doi:10.1016/j.resuscitation.2021.08.050

Cited by 5 publications

(9 citation statements)

References 25 publications

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“…This is the clinical phase, when intense treatment must be rapidly instituted to limit ongoing organ damage attributable to myocardial depression followed by superimposed inflammatory vasodilatation, 6 which cause low peripheral perfusion. In this regard, it is known from a prior study by our group 28 that low peripheral perfusion expressed by low values of the peripheral perfusion index, which is the ratio of the pulsatile blood flow to the nonpulsatile or static blood in peripheral tissue obtainable from a pulse oximeter, correlates with ECG changes, such as ST‐segment elevation in >1 segment, QRS widening and bundle‐branch block morphology, thus affecting ECG reliability. We have also shown that low peripheral perfusion was an independent predictor of 30‐day mortality and poor neurologic outcome.…”

Section: Discussionmentioning

confidence: 98%

Association Between Postresuscitation 12‐Lead ECG Features and Early Mortality After Out‐of‐Hospital Cardiac Arrest: A Post Hoc Subanalysis of the PEACE Study

Gentile

Baldi

Klersy

et al. 2023

JAHA

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Background Once the return of spontaneous circulation after out‐of‐hospital cardiac arrest is achieved, a 12‐lead ECG is strongly recommended to identify candidates for urgent coronary angiography. ECG has no apparent role in mortality risk stratification. We aimed to assess whether ECG features could be associated with 30‐day survival in patients with out‐of‐hospital cardiac arrest. Methods and Results All the post‐return of spontaneous circulation ECGs from January 2015 to December 2018 in 3 European centers (Pavia, Lugano, and Vienna) were collected. Prehospital data were collected according to the Utstein style. A total of 370 ECGs were collected: 287 men (77.6%) with a median age of 62 years (interquartile range, 53–70 years). After correction for the return of spontaneous circulation‐to‐ECG time, age >62 years (hazard ratio [HR], 1.78 [95% CI, 1.21–2.61]; P =0.003), female sex (HR, 1.5 [95% CI, 1.05–2.13]; P =0.025), QRS wider than 120 ms (HR, 1.64 [95% CI, 1.43–1.87]; P <0.001), the presence of a Brugada pattern (HR, 1.49 [95% CI, 1.39–1.59]; P <0.001), and the presence of ST‐segment elevation in >1 segment (HR, 1.75 [95% CI, 1.59–1.93]; P <0.001) were independently associated with 30‐day mortality. A score ranging from 0 to 26 was created, and by dividing the population into 3 tertiles, 3 classes of risk were found with significantly different survival rate at 30 days (score 0–4, 73%; score 5–7, 66%; score 8–26, 45%). Conclusions The post‐return of spontaneous circulation ECG can identify patients who are at high risk of mortality after out‐of‐hospital cardiac arrest earlier than other forms of prognostication. This provides important risk stratification possibilities in postcardiac arrest care that could help to direct treatments and improve outcomes in patients with out‐of‐hospital cardiac arrest.

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Section: Discussionmentioning

confidence: 98%

Association Between Postresuscitation 12‐Lead ECG Features and Early Mortality After Out‐of‐Hospital Cardiac Arrest: A Post Hoc Subanalysis of the PEACE Study

Gentile

Baldi

Klersy

et al. 2023

JAHA

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“…Low perfusion index has been shown to correlate strongly with likelihood of a false-positive ECG, with the postulated mechanism being hypoperfusion-mediated transmyocardial ischemia that is independent of acute thrombotic coronary artery occlusion. 21 With this in mind, when there is ambiguity regarding the implications of the post-ROSC ECG, serial ECGs performed >30 minutes after ROSC can provide additional information regarding the accuracy of the ST changes, which can help guide the decision to proceed with immediate or delayed coronary angiography.…”

Section: Historymentioning

confidence: 99%

Cardiac Catheterization Laboratory Management of the Comatose Adult Patient With an Out-of-Hospital Cardiac Arrest: A Scientific Statement From the American Heart Association

Tamis-Holland,

Menon,

Johnson

et al. 2024

Circulation

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Out-of-hospital cardiac arrest is a leading cause of death, accounting for ≈50% of all cardiovascular deaths. The prognosis of such individuals is poor, with <10% surviving to hospital discharge. Survival with a favorable neurologic outcome is highest among individuals who present with a witnessed shockable rhythm, received bystander cardiopulmonary resuscitation, achieve return of spontaneous circulation within 15 minutes of arrest, and have evidence of ST-segment elevation on initial ECG after return of spontaneous circulation. The cardiac catheterization laboratory plays an important role in the coordinated Chain of Survival for patients with out-of-hospital cardiac arrest. The catheterization laboratory can be used to provide diagnostic, therapeutic, and resuscitative support after sudden cardiac arrest from many different cardiac causes, but it has a unique importance in the treatment of cardiac arrest resulting from underlying coronary artery disease. Over the past few years, numerous trials have clarified the role of the cardiac catheterization laboratory in the management of resuscitated patients or those with ongoing cardiac arrest. This scientific statement provides an update on the contemporary approach to managing resuscitated patients or those with ongoing cardiac arrest.

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“…While conventional diagnostic approaches, such as electrocardiograms (ECGs) and cardiac biomarker analysis, have remained pivotal, their utility can be substantially amplified when synchronized with innovative tools like the Peripheral Perfusion Index (PI). The merit of PI emerges vividly in its capacity to instantaneously unravel the complexities of hemodynamic parameters, shedding light on physiological realms that are ordinarily less palpable through traditional monitoring [3][4][5][6]. With its potential to deftly differentiate diagnostic conundrums, adeptly assess risk, and proficiently navigate the intricate management maze of ACS, PI promises not only an enhanced diagnostic acumen but also a more nuanced patient-centric care strategy in the emergency department [4].…”

Section: Introductionmentioning

confidence: 99%

“…The merit of PI emerges vividly in its capacity to instantaneously unravel the complexities of hemodynamic parameters, shedding light on physiological realms that are ordinarily less palpable through traditional monitoring [3][4][5][6]. With its potential to deftly differentiate diagnostic conundrums, adeptly assess risk, and proficiently navigate the intricate management maze of ACS, PI promises not only an enhanced diagnostic acumen but also a more nuanced patient-centric care strategy in the emergency department [4].…”

Section: Introductionmentioning

confidence: 99%

“…Conversely, PI, with its inherently non-invasive methodology and the ability to indirectly assess microvascular peripheral perfusion, emerges as a notably accessible and versatile diagnostic adjunct. The preliminary indications of PI's efficacy in evaluating cardiac function, particularly in critical, high-stakes contexts such as ACS, is emblematic of a broader movement towards incorporating noninvasive diagnostic strategies into the emergency care matrix [3,4,6].…”

Section: Introductionmentioning

confidence: 99%

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Prognostic Effectiveness of Blood Gas Lactate Values and Peripheral Perfusion Indices in Patients Diagnosed with Acute Coronary Syndrome in The Emergency Department

ŞAHİN,

KIRCA

2023

Preprint

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This study aimed to investigate the potential correlations and differences between patients with Acute Coronary Syndrome (ACS) and controls. Emphasis was placed on examining the relationship between arterial blood gas PH value and arterial blood gas lactate value as well as assessing the utility of the Peripheral Perfusion Index (PI) in ACS management. Materials and Methods: A prospective observational study was conducted between January 1, 2023, and July 1, 2023, involving 60 ACS patients and 30 control subjects in an emergency department. The diagnosis of ACS was confirmed by experienced emergency physicians, and various parameters, such as peripheral perfusion index, blood gas values, and cardiac biomarker values, were collected. The statistical analyses included Pearson’s chi-square test, Mann-Whitney U test, Student’s t-test, and others, using SPSS version 18.0. There were significant differences in the mean age, perfusion index, and lactate levels between the patient and control groups. A robust negative correlation was found between age and PI, and a moderate negative correlation was observed between pH and lactate levels (r = -0.301, p=0.004). The perfusion index in the patient group was significantly lower, indicating its potential diagnostic utility. The findings demonstrate the importance of arterial blood gas pH and lactate values in understanding ACS patient profiles, emphasizing the potential of PI as a noninvasive diagnostic method. The negative correlation between pH and lactate levels may offer valuable insights into risk stratification and treatment strategies for patients with ACS.

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Peripheral perfusion index and diagnostic accuracy of the post-ROSC electrocardiogram in patients with medical out-of-hospital cardiac arrest

Cited by 5 publications

References 25 publications

Association Between Postresuscitation 12‐Lead ECG Features and Early Mortality After Out‐of‐Hospital Cardiac Arrest: A Post Hoc Subanalysis of the PEACE Study

Association Between Postresuscitation 12‐Lead ECG Features and Early Mortality After Out‐of‐Hospital Cardiac Arrest: A Post Hoc Subanalysis of the PEACE Study

Cardiac Catheterization Laboratory Management of the Comatose Adult Patient With an Out-of-Hospital Cardiac Arrest: A Scientific Statement From the American Heart Association

Prognostic Effectiveness of Blood Gas Lactate Values and Peripheral Perfusion Indices in Patients Diagnosed with Acute Coronary Syndrome in The Emergency Department

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