Abstract 172: Utility Of Cerebrospinal Fluid Lactate To Predict Neurological Prognosis In Patients With Out Of Hospital Cardiac Arrest Undergoing Target Temperature Management

Abstract

Utility of cerebrospinal fluid lactate to predict neurological prognosis in patients with out of hospital cardiac arrest undergoing target temperature managementLactate is a predictor of poor neurological prognosis in patients with OHCA undergoing TTM.However, CSF lactate is independent on serum lactate, and has rapid turn around time. Therefore, we investigated the prognostic value of CSF lactate, measured every 2 h for 24 h after ROSC and the incidence of mitochondrial dysfunction (MD) and ischaemia with increased CSF lactate in the groups with good and poor neurological prognosis.This was a prospective observational study conducted from March 2021 to April 2022 (**** IRB 2020-04-051). All patients were monitored with aEEG. Serum and CSF were obtained using a radial arterial and a lumbar catheter. 22 patients were required through sample size calculation. The comparison of lactate between the two groups was evaluated using the generalized estimating equation. The AUROC was used to identify the prognostic values of lactate (Fig. 1, Table 1). Parameters measured immediately, and 24 h after ROSC were not different between the two groups (Table 2). CSF lactate level was higher in the group with poor neurological prognosis, and CSF lactate showed better performance in predicting poor neurological prognosis, even after 6 h post ROSC (Table 3, 4, Fig. 2). Additionally, the neurological prognosis was poor when MD or ischaemia in brain persisted more than 16 h after ROSC (Fig. 3).This study demonstrated that CSF lactate was a valuable tool in predicting poor neurological prognosis, and cases in which MD or ischaemia in the brain persisted more than 16 h after ROSC had poor outcome.