ENHANCED ECG MONITORING OF COVID-19 PATIENTS.
Heart Rhythm. 2020 May 05;:
Authors: Jain S, Workman V, Ganeshan R, Obasare ER, Burr A, DeBiasi RM, Freeman JV, Akar J, Lampert R, Rosenfeld LE
BACKGROUND: Many of the drugs being used in the treatment of the ongoing pandemic coronavirus disease 2019 (COVID-19) are associated with QT prolongation. Expert guidance supports ECG monitoring to optimize patient safety.
OBJECTIVE: To establish an enhanced process for ECG monitoring of patients being treated for COVID-19.
METHODS: We created an SBAR (Situation Background Assessment Recommendation Tool) identifying the indication for ECGs in COVID-19 patients, and tagged these ECGs to ensure prompt over reading and identification of those with QT prolongation (QTc >470 ms for QRS < 120 ms, QTc > 500 ms for QRS > 120 ms). This triggered a phone call from the electrophysiology service to the primary team to provide management guidance and a formal consultation if requested.
RESULTS: During a 2-week period we reviewed 2006 ECGs, corresponding to 524 unique patients, of whom 103 (19.7%) met SBAR defined criteria for QT prolongation. When compared to those without QT prolongation, these patients were more often in the intensive care unit (58.3% vs 35.4%) and more likely to be intubated (31.1 vs 18.1%). Fifty patients with QT prolongation (48.5%) had electrolyte abnormalities, 98 (95.1%) were on COVID-19 related QT prolonging medications, and 62 (60.2%) were on 1-4 additional non COVID-19 related QT prolonging drugs. Electrophysiology recommendations were given to limit modifiable risk factors. No patient developed torsade de pointes.
CONCLUSION: This process functioned efficiently, identified a high percentage of patients with QT prolongation, and led to relevant interventions. Arrhythmias were rare. No patient developed torsade de pointes.
PMID: 32387247 [PubMed - as supplied by publisher]