Abstract
No studies have evaluated whether administering intravenous lactated Ringer's (LR) solution to patients with out-of-hospital cardiac arrest (OHCA) improves their outcomes, to our knowledge. Therefore, we examined the association between prehospital use of LR solution and patients' return of spontaneous circulation (ROSC), 1-month survival, and neurological or physical outcomes at 1 month after the event. We conducted a prospective, non-randomized, observational study using national data of all patients with OHCA from 2005 through 2009 in Japan. We performed a propensity analysis and examined the association between prehospital use of LR solution and short- and long-term survival. The study patients were ≥18 years of age, had an OHCA before arrival of EMS personnel, were treated by EMS personnel, and were then transported to hospitals. A total of 531,854 patients with OHCA met the inclusion criteria. Among propensity-matched patients, compared with those who did not receive pre-hospital intravenous fluids, prehospital use of LR solution was associated with an increased likelihood of ROSC before hospital arrival (odds ratio [OR] adjusted for all covariates [95% CI] = 1.239 [1.146-1.339] [p<0.001], but with a reduced likelihood of 1-month survival with minimal neurological or physical impairment (cerebral performance category 1 or 2, OR adjusted for all covariates [95% CI] = 0.764 [0.589-0.992] [p = 0.04]; and overall performance category 1 or 2, OR adjusted for all covariates [95% CI] = 0.746 [0.573-0.971] [p = 0.03]). There was no association between prehospital use of LR solution and 1-month survival (OR adjusted for all covariates [95% CI] = 0.960 [0.854-1.078]). In Japanese patients experiencing OHCA, the prehospital use of LR solution was independently associated with a decreased likelihood of a good functional outcome 1 month after the event, but with an increased likelihood of ROSC before hospital arrival. Prehospital use of LR solution was not associated with 1-month survival. Further study is necessary to verify these findings. Please see later in the article for the Editors' Summary.
Highlights
Intravenous (IV) fluid loading is performed during prehospital resuscitation for patients who have out-of-hospital cardiac arrest (OHCA) in Japan
In Japanese patients experiencing OHCA, the prehospital use of lactated Ringer (LR) solution was independently associated with a decreased likelihood of a good functional outcome 1 month after the event, but with an increased likelihood of return of spontaneous circulation (ROSC) before hospital arrival
Prehospital use of LR solution was not associated with 1-month survival
Summary
Intravenous (IV) fluid loading is performed during prehospital resuscitation for patients who have out-of-hospital cardiac arrest (OHCA) in Japan. According to our systematic literature review on arterial lactate concentrations among patients with OHCA, these patients have already developed lactic acidosis at hospital admission in the majority of studies (Table S1). No studies have evaluated whether administering intravenous lactated Ringer’s (LR) solution to patients with out-of-hospital cardiac arrest (OHCA) improves their outcomes, to our knowledge. A condition in which the heart suddenly stops pumping, is caused by problems with the heart’s internal electrical system, which controls the rate and rhythm of the heart contractions that pump blood around the body. If this electrical system malfunctions, an abnormal heartbeat or ‘‘arrhythmia’’ develops that, in some cases, causes cardiac arrest. Cardiopulmonary resuscitation (CPR; chest compression to pump the heart and mouth-to-mouth resuscitation to inflate the lungs) and early defibrillation (delivery of an electric shock to the heart to restore its normal rhythm) reduce the risk of death and permanent organ damage after cardiac arrest
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