Abstract
BackgroundElevated lactate concentration has been associated with increased mortality after out-of-hospital cardiac arrest (CA). We investigated the variables associated with high blood lactate concentrations and explored the relationship between blood lactate and neurological outcome in this setting.MethodsThis was a retrospective analysis of an institutional database that included all adult (> 18 years) patients admitted to a multidisciplinary Department of Intensive Care between January 2009 and January 2013 after resuscitation from CA. Blood lactate concentrations were collected at hospital admission and 6, 12, 24 and 48 h thereafter. Neurological outcome was evaluated 3 months post-CA using the Cerebral Performance Category (CPC) score: a CPC of 3–5 was used to define a poor outcome.ResultsOf the 236 patients included, 162 (69%) had a poor outcome. On admission, median lactate concentrations (5.3[2.9–9.0] vs. 2.5[1.5–5.5], p < 0.001) and cardiovascular sequential organ failure assessment (cSOFA) score (3[0–4] vs. 0[0–3], p = 0.003) were higher in patients with poor than in those with favourable outcomes. Lactate concentrations were higher in patients with poor outcomes at all time points. Lactate concentrations were similar in patients with out-of-hospital and in-hospital CA at all time points. After adjustment, high admission lactate was independently associated with a poor neurological outcome (OR 1.18, 95% CI 1.08–1.30; p < 0.001). In multivariable analysis, use of vasopressors and high PaO2 on admission, longer time to return of spontaneous circulation and altered renal function were associated with high admission lactate concentrations.ConclusionsHigh lactate concentrations on admission were an independent predictor of poor neurological recovery post-CA, but the time course was not related to outcome. Prolonged resuscitation, use of vasopressors, high PaO2 and altered renal function were predictors of high lactate concentrations.
Highlights
Elevated lactate concentration has been associated with increased mortality after out-of-hospital cardiac arrest (CA)
Every year, between 37 and 100 per 100,000 inhabitants have an out-of-hospital cardiac arrest (OHCA) in Western countries, with approximately 10% surviving to hospital discharge [1, 2]
The aims of this study were, to: (a) evaluate whether any lactate-related variable was associated with neurological outcome; (b) identify the variables associated with high lactate concentrations after CA; and (c) explore the differences in lactate concentrations between in-hospital CA (IHCA) and OHCA
Summary
Elevated lactate concentration has been associated with increased mortality after out-of-hospital cardiac arrest (CA). Intensive Care (2017) 7:101 likely to die than those with lower concentrations [6, 7] In this setting, blood lactate concentrations may be considered as a marker of prolonged hypoperfusion or poor resuscitation. Other studies have suggested that a faster decrease in lactate concentrations during the early hours after resuscitation may be correlated with better survival [8,9,10]. This decrease may reflect more rapid haemodynamic stabilization with therapy. These studies included only patients with OHCA and the importance of lactate concentrations in IHCA survivors remains uncertain. Few data are available on the impact of lactate concentrations and their evolution on neurological recovery, and the variables associated with high blood lactate after CA have not been well studied [7]
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