Abstract

Background: In cardiac arrest survivors, metabolic parameters [pH value, lactate concentration, and base deficit (BD)] are routinely added to peri-arrest factors (including age, sex, bystander cardiopulmonary resuscitation, shockable first rhythm, resuscitation duration, adrenaline dose) to enhance early outcome prediction. However, the additional value of this strategy remains unclear.Methods: We used our resuscitation database to screen all patients ≥18 years who had suffered in- or out-of-hospital cardiac arrest (IHCA, OHCA) between January 1st, 2005 and May 1st, 2019. Patients with incomplete data, without return of spontaneous circulation or treatment with sodium bicarbonate were excluded. To analyse the added value of metabolic parameters to prognosticate neurological function, we built three models using logistic regression. These models included: (1) Peri-arrest factors only, (2) peri-arrest factors plus metabolic parameters and (3) metabolic parameters only. Receiver operating characteristics curves regarding 30-day good neurological function (Cerebral Performance Category 1-2) were analysed.Results: A total of 2,317 patients (OHCA: n = 1842) were included. In patients with OHCA, model 1 and 2 had comparable predictive value. Model 3 was inferior compared to model 1. In IHCA patients, model 2 performed best, whereas both metabolic (model 3) and peri-arrest factors (model 1) demonstrated similar power. PH, lactate and BD had interchangeable areas under the curve in both IHCA and OHCA.Conclusion: Although metabolic parameters may play a role in IHCA, no additional value in the prediction of good neurological outcome could be found in patients with OHCA. This highlights the importance of accurate anamnesis especially in patients with OHCA.

Highlights

  • Sudden cardiac arrest is a global health burden with an incidence of 86.4/100.000 person-years in Europe [1]

  • A total of 475 (20.5%) patients were resuscitated from IHCA, whereas 1842 (79.5%) patients were treated after OHCA

  • The main finding of our analysis is that the addition of metabolic parameters to peri-arrest factors adds no value to early outcome prediction after successful resuscitation from OHCA

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Summary

Introduction

Sudden cardiac arrest is a global health burden with an incidence of 86.4/100.000 person-years in Europe [1]. Peri-arrest factors associated with poor neurological outcome after cardiopulmonary resuscitation (CPR) include unwitnessed arrest, no bystander resuscitation, longer duration to return of spontaneous circulation (ROSC), non-shockable rhythms, higher cumulative doses of adrenaline (epinephrine) and increasing age [3,4,5]. Clinicians tend to rely more on objective metabolic parameters including pH value, lactate levels and base deficit (BD) measured in the blood sample drawn on admission. High lactate levels on hospital admission are associated with poor survival and poor neurological outcome after sudden cardiac arrest [7, 8]. Metabolic parameters [pH value, lactate concentration, and base deficit (BD)] are routinely added to peri-arrest factors (including age, sex, bystander cardiopulmonary resuscitation, shockable first rhythm, resuscitation duration, adrenaline dose) to enhance early outcome prediction.

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