Change in out-of-hospital 12-lead ECG diagnostic classification following resuscitation from cardiac arrest

Tom P. Aufderheide, Thomas W. Engel, Hadi O. Saleh, David D. Gutterman, Benjamin W. Weston, Paul E. Pepe, John E. Baker, Jacob Labinski, Guillaume Debaty, Lujia Tang, Aniko Szabo, Rajat Kalra, Demetris Yannopoulos, M. Riccardo Colella

Research output: Contribution to journalArticlepeer-review


Introduction: We evaluated the incidence of change in serial 12-lead electrocardiogram (ECG) diagnostic classifications in patients resuscitated from out-of-hospital (OH) cardiac arrest (OHCA) comparing OH to emergency department (ED) ECGs. Methods: This retrospective case series included: 1) adults (≥ 18 years old), 2) resuscitated from OHCA, 3) ≥ 1 OH and 1 ED ECG/patient, and 4) emergency medical services (EMS) transport to the study hospital. OH and ED ECGs were classified as: 1) STEMI (ST-segment Elevation Myocardial Infarction), 2) Ischemic, and 3) Non-ischemic. Two ED physicians and one cardiologist independently classified all ECGs, then generated a consensus opinion classification for each ECG based on American Heart Association's 2018 Expert Consensus criteria. The most ischemic OH ECG classification was compared with the last ED ECG classification. Results: From 7/27/12 to 7/18/19, 176 patients were entered with a mean age of 61.2 ± 16.6 years; 102/176 (58%) were male. Overall, 504 OH and ED 12-lead ECGs were acquired (2.9 ECGs/patient). ECG classification inter-rater reliability kappa score was 0.63 ± 0.02 (substantial agreement). Overall, 86/176 (49%) changed ECG classification from the OH to ED setting; 69/86 (80%) of these ECGs changed from more to less ischemic classifications. Of 49 OH STEMI ECG classifications, 33/49 (67%) changed to a less ischemic (non-STEMI) ED ECG classification. Conclusions: Change in 12-lead ECG classification from OH to ED setting in patients resuscitated from OHCA was common (49%). The OH STEMI classification changed to a less ischemic (non-STEMI) ED classification in 67% of cases.

Original languageEnglish (US)
Pages (from-to)45-52
Number of pages8
StatePublished - Dec 2021

Bibliographical note

Funding Information:
The authors thank Ian B. K. Martin, MD, MBA, Professor and System Chair in the Department of Emergency Medicine at the Medical College of Wisconsin, for funding this research. He had no role in the study design, collection, analysis and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication. We also thank the Division of EMS Medicine, Office of Emergency Management, Milwaukee County EMS, and Milwaukee County EMS providers without whose dedication to research and excellence in patient care this study would not have been possible. We further recognize and appreciate the logistical support of the Resuscitation Research Center personnel in the Department of Emergency Medicine at the Medical College of Wisconsin.

Publisher Copyright:
© 2021 Elsevier B.V.


  • 12-lead electrocardiogram
  • Acute myocardial infarction
  • Cardiac arrest
  • Emergency medical services
  • Out-of-hospital
  • Resuscitation

PubMed: MeSH publication types

  • Journal Article


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