KVAL: ECG Biomarker predicting cardiac arrest in hypothermic patients and patients on psychopharmaceuticals.

Accidental hypothermia has a mortality rate up to 40%. The leading cause of death for this patient group is cardiac arrest. Although low body temperatures can protect the brain when the heart is beating, rewarming patients is complicated due to risk of arrhythmias. Administration of antiarrhythmic drugs is a possibility to mitigate this risk, however such administration represents a risk in itself, due to a reduced metabolic capacity of the cold, potentially causing toxicity of the drugs administered. Thus, guidelines are recommending clinicians to withhold such drugs until core temperatures above 30? have been reached. An electrocardiogram (ECG) can monitor and alert healthcare personnel (HCPs) of irregularities in the heart rhythm during re-warming, but cannot predict cardiac arrest. Recent research has identified an ECG-marker that could predict ventricular arrhythmias before it develops to cardiac arrest, making it possible for HCPs to take preventive actions by administrating antiarrhythmic drugs for patients at risk. Some prescribed drugs such as antidepressants affects cardiac physiology in a similar manner to hypothermia and can cause arrythmias. There are currently no methods to identify the patients at risk of cardiac arrest due to the prescribed drugs. The ECG biomarker described in this project can potentially help identify patients where drug-treatment should be discontinued to avoid cardiac arrest. This project aims to validate and refine the ECG biomarker for patients prescribed antidepressant drugs ant how to best implement it in trauma wards, ambulances and care units treating hypothermic patients.

Outcome: We've had a good collaboration with the industry partner in the project and confirmed the ease of implementing the biomarker into the ECG interpretation software. Thus from a technical point of view the biomarkers are ready to be implemented when the biomarkers have been clinically validated. Impact: We've been in contact with a wast number of physiciatric clinicians in Norway making them aware of the biomarker and the potential for a non-invasive method to identify patients at risk, and gotten their feedback on requirements for implementation. In addition suprising results from the project gives new insight of the electrophysiology of the heart of the patients prescribed the most commonly used antidepressive medication. This might spark further research within this field.