Abstract
We aimed to investigate the association between serum lactate levels during cardiopulmonary resuscitation (CPR) and survival in patients with out-of-hospital cardiac arrest (OHCA). From the database of a multicenter registry on OHCA patients, we included adult nontraumatic OHCA patients transported to the hospital with ongoing CPR. Based on the serum lactate levels during CPR, the patients were divided into four quartiles: Q1 (≤ 10.6 mEq/L), Q2 (10.6–14.1 mEq/L), Q3 (14.1–18.0 mEq/L), and Q4 (> 18.0 mEq/L). The primary outcome was 1-month survival. Among 5226 eligible patients, the Q1 group had the highest 1-month survival (5.6% [74/1311]), followed by Q2 (3.6% [47/1316]), Q3 (1.7% [22/1292]), and Q4 (1.0% [13/1307]) groups. In the multivariable logistic regression analysis, the adjusted odds ratio of Q4 compared with Q1 for 1-month survival was 0.24 (95% CI 0.13–0.46). 1-month survival decreased in a stepwise manner as the quartiles increased (p for trend < 0.001). In subgroup analysis, there was an interaction between initial rhythm and survival (p for interaction < 0.001); 1-month survival of patients with a non-shockable rhythm decreased when the lactate levels increased (p for trend < 0.001), but not in patients with a shockable rhythm (p for trend = 0.72). In conclusion, high serum lactate level during CPR was associated with poor 1-month survival in OHCA patients, especially in patients with non-shockable rhythm.
Highlights
We aimed to investigate the association between serum lactate levels during cardiopulmonary resuscitation (CPR) and survival in patients with out-of-hospital cardiac arrest (OHCA)
Prospective registry in Osaka, Japan, designed to accumulate both pre- and in-hospital information on treatments and laboratory data of OHCA patients, this study aimed to investigate the association between serum lactate levels during CPR and survival outcomes in OHCA patients who did not achieve return of spontaneous circulation (ROSC) in prehospital settings
We excluded 313 children aged < 18 years, 1536 patients with traumatic causes, 101 patients whose OHCA was witnessed by on-scene emergency medical services (EMS) personnel, 190 patients whose first documented rhythm was unknown, 881 patients who achieved ROSC in prehospital settings, 44 patients who presented the pulse at hospital arrival, and 47 patients for whom extracorporeal membrane oxygenation (ECMO) was initiated before lactate measurement
Summary
We aimed to investigate the association between serum lactate levels during cardiopulmonary resuscitation (CPR) and survival in patients with out-of-hospital cardiac arrest (OHCA). Abbreviations CAG Coronary angiography CCMC Critical care medical center CI Confidence intervals CPC Cerebral Performance Category CPR Cardiopulmonary Resuscitation CRITICAL Comprehensive Registry of Intensive Care for OHCA Survival ECMO Extracorporeal membrane oxygenation EMS Emergency-medical-services FDMA Fire and Disaster Management Agency OHCA Out-of-hospital cardiac arrest OR Odds ratios ROC Receiver operating characteristics ROSC Return of spontaneous circulation TTM Target temperature management. Advanced interventions before the return of spontaneous circulation (ROSC), such as the implementation of extracorporeal membrane oxygenation (ECMO) and target temperature management (TTM), have been attempted to improve the prognosis of cardiac arrest patients[4,5] It is not easy for emergency and/or intensive care physicians to decide whether to proceed to the advanced interventions during cardiopulmonary resuscitation (CPR) or to stop CPR during resuscitation efforts for OHCA patients who do not achieve ROSC6,7. A marker, which can be measured during CPR, can facilitate the decision-making process in the provision of intensive care for OHCA patients to improve their outcomes
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
