Good Neurological Outcome In Patients Research Articles

Better lactate clearance associated with good neurologic outcome in survivors who treated with therapeutic hypothermia after out-of-hospital cardiac arrest

IntroductionSeveral methods have been proposed to evaluate neurological outcome in out-of-hospital cardiac arrest (OHCA) patients. Blood lactate has been recognized as a reliable prognostic marker for trauma, sepsis, or cardiac arrest. The objective of this study was to examine the association between initial lactate level or lactate clearance and neurologic outcome in OHCA survivors who were treated with therapeutic hypothermia.MethodsThis retrospective cohort study included patients who underwent protocol-based 24-hour therapeutic hypothermia after OHCA between January 2010 and March 2012. Serum lactate levels were measured at the start of therapy (0 hours), and after 6 hours, 12 hours, 24 hours, 48 hours and 72 hours. The 6 hour and 12 hour lactate clearance were calculated afterwards. Patients’ neurologic outcome was assessed at one month after cardiac arrest; good neurological outcome was defined as Cerebral Performance Category one or two. The primary outcome was an association between initial lactate level and good neurologic outcome. The secondary outcome was an association between lactate clearance and good neurologic outcome in patients with initial lactate level >2.5 mmol/l.ResultsOut of the 76 patients enrolled, 34 (44.7%) had a good neurologic outcome. The initial lactate level showed no significant difference between good and poor neurologic outcome groups (6.07 ±4 .09 mmol/L vs 7.13 ± 3.99 mmol/L, P = 0.42), However, lactate levels at 6 hours, 12 hours, 24 hours, and 48 hours in the good neurologic outcome group were lower than in the poor neurologic outcome group (3.81 ± 2.81 vs 6.00 ± 3.22 P <0.01, 2.95 ± 2.07 vs 5.00 ± 3.49 P <0.01, 2.17 ± 1.24 vs 3.86 ± 3.92 P <0.01, 1.57 ± 1.02 vs 2.21 ± 1.35 P = 0.03, respectively). The secondary analysis showed that the 6-hour and 12-hour lactate clearance was higher for good neurologic outcome patients (35.3 ± 34.6% vs 6.89 ± 47.4% P = 0.01, 54.5 ± 23.7% vs 25.6 ± 43.7% P <0.01, respectively). After adjusting for potential confounding variables, the 12-hour lactate clearance still showed a statistically significant difference (P = 0.02).ConclusionThe lactate clearance rate, and not the initial lactate level, was associated with neurological outcome in OHCA patients after therapeutic hypothermia.

Abstract 19369: Relation Between Sedative and Outcomes in Patients Undergoing Mild Therapeutic Hypothermia Following Cardiac Arrest

Introduction: Great variability in sedation protocols currently exists in treating patients undergoing mild therapeutic hypothermia (MTH) following cardiac arrest. Even though sedation may confound outcome prediction, the optimal agent to use remains unknown. Methods: We retrospectively collected data on 201 consecutive adult patients admitted to Hartford Hospital who survived a cardiac arrest and were admitted to our cardiac intensive care unit (CICU). Use of sedatives, including propofol, midazolam, and lorazepam, was collected. The main outcome of interest was survival with good neurologic outcome defined using the Pittsburgh cerebral performance category (CPC) scale of 1-2. Multivariate logistic regression was used to control for potential confounders and identify independent predictors of good outcome. Results: Of the 201 patients (mean age 61 ± 15 years), 99 (49.3%) had VF or VT and 102 (51.7%) had PEA or asystole. During their CICU stay, 172 (85.6%) patients received propofol, 134 (66.7%) received midazolam, and 111 (55.2%) received lorazepam. A positive correlation was seen between rate of survival with good neurologic outcome in patients who received propofol (p=0.01) or midazolam (p=0.021) while a negative correlation was seen with lorazepam (p=0.01). Multivariate analysis showed that propofol use (p=0.001) was a positive independent predictor of survival with good neurologic outcome during hospitalization in our population whereas lorazepam use (p=0.004), history of diabetes (p=0.004), and either asystole (p=0.004) or PEA (p=0.002) were negative predictors. Conclusions: In our population, use of propofol or midazolam during MTH following cardiac arrest was positively associated with a good outcome while lorazepam use had a negative association. Direct head-to-head studies are required to identify the most appropriate sedation strategy to use in this population.