High resolution ECG-aided early prognostic model for comatose survivors of out of hospital cardiac arrest

•ECG improves early prognostication in unconscious survivors of OHCA.•Two prognostication scores have been created: one for MIH and one for normothermia.•OHCA-related, clinical variables as well as advanced ECG variables were used.•Hypothermic score resulted in AUC of 0.82 and accuracy of 80% for 1-month survival.•Normothermic score resulted in AUC of 0.88 and accuracy of 85% for 1-month survival.

Out of hospital cardiac arrest (OHCA) has a high mortality despite modern treatment. Reliable early prognosis in OHCA could significantly improve clinical decision making. We explored prognostic utility of advanced ECG parameters, obtained from high-resolution ECG, in combination with clinical and OHCA-related parameters during treatment with mild induced hypothermia (MIH) and after rewarming in unconscious survivors of OHCA. Ninety-two patients during MIH and 66 after rewarming were included. During MIH, a score based on initial rhythm, QRS-upslope and systolic pressure resulted in an area under curve (AUC) of 0.82 and accuracy of 80% for survival. After rewarming, a score based on admission rhythm, sum of 12 lead QRS voltages, and mean lateral ST segment level in leads I and V6 resulted in an AUC of 0.88 and accuracy of 85% for survival. ECG can assist with early prognostication in unconscious survivors of OHCA during MIH and after rewarming.