Abstract
BackgroundThere is limited information on the predictive accuracy of commonly used predictors, such as lactate, pH or serum potassium for the survival among out-of-hospital cardiac arrest (OHCA) patients with hypothermia. This study aimed to identify the predictive accuracy of these biomarkers for survival among OHCA patients with hypothermia.MethodsIn this retrospective analysis, we analyzed the data from a multicenter, prospective nationwide registry among OHCA patients transported to emergency departments in Japan (the JAAM-OHCA Registry). We included all adult (≥18 years) OHCA patients with hypothermia (≤32.0 °C) who were registered from June 2014 to December 2017 and whose blood test results on hospital arrival were recorded. We calculated the predictive accuracy of pH, lactate, and potassium for 1-month survival.ResultsOf the 34,754 patients in the JAAM-OHCA database, we included 754 patients from 66 hospitals. The 1-month survival was 5.8% (44/754). The areas under the curve of the predictors and 95% confidence interval were as follows: pH 0.829 [0.767–0.877] and lactate 0.843 [0.793–0.882]. On setting the cutoff points of 6.9 in pH and 120 mg/dL (13.3 mmol/L) in lactate, the predictors had a high sensitivity (lactate: 0.91; pH 0.91) and a low negative likelihood ratio (lactate: 0.14; pH 0.13), which are suitable to exclude survival to 1 month. Furthermore, in additional analysis that included only the patients with potassium values available, a cutoff point of 7.0 (mmol/L) for serum potassium had high sensitivity (0.96) and a low negative likelihood ratio (0.09).ConclusionThis study indicated the predictive accuracy of serum lactate, pH, and potassium for 1-month survival among adult OHCA patients with hypothermia. These biomarkers may help define a more appropriate resuscitation strategy.
Highlights
There is limited information on the predictive accuracy of commonly used predictors, such as lactate, pH or serum potassium for the survival among out-of-hospital cardiac arrest (OHCA) patients with hypothermia
We showed the discriminatory ability of each predictor for 1-month survival by using the receiver-operating characteristic curve (ROC) and area under the curve (AUC) with 95% confidence interval (CI)
Key observation From a large-scale hospital-based registry in Japan, we demonstrated the predictive accuracy of lactate, pH, and potassium for 1-month survival in OHCA patients with moderate-to-severe hypothermia who were transported to emergency departments
Summary
There is limited information on the predictive accuracy of commonly used predictors, such as lactate, pH or serum potassium for the survival among out-of-hospital cardiac arrest (OHCA) patients with hypothermia. In moderate-to-severe hypothermia of less than 32 °C, the risk of arrhythmia and cardiac arrest increases [1] For such patients who progressed to cardiac arrest, the guidelines suggest extracorporeal life support (ECLS) and aggressive internal rewarming by using veno-arterial extracorporeal membrane oxygenation (VA ECMO) based on the classic dictum that “No one is dead until warm and dead” [2, 3]. This is because cardiac arrest patients with hypothermia have been reported to achieve good clinical outcomes even if the cardiac arrest was sustained for a long duration [2,3,4,5,6]. An accurate predictor of the outcome is necessary among cardiac arrest patients with hypothermia
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