Use of serum lactate levels to predict survival for patients with out-of-hospital cardiac arrest: A cohort study

Background: Serum lactate reflects hypoxic insult in many conditions, but its role as prognostic markers after cardiac arrest is still controversial. This study aimed to investigate the association between serum lactate levels during cardiopulmonary resuscitation (CPR) and survival in patients with out-of-hospital cardiac arrest (OHCA). Methods: This study analyzed the data of the Osaka Comprehensive Registry of Intensive Care for OHCA Survival, a prospective multicenter observational study of 14 participating institutions in Osaka Prefecture, Japan. We enrolled consecutive patients aged ≥18 years who were transported to the hospital with ongoing CPR from 2013 to 2016. Based on the serum lactate levels, OHCA patients were divided into 4 quartiles: Q1 (lactate ≤10.6 mEq/L), Q2 (10.6< lactate ≤14.1 mEq/L), Q3 (14.1< lactate ≤18.0 mEq/L) and Q4 (lactate >18.0 mEq/L). The relationships between serum lactate level before return of spontaneous circulation (ROSC) and 1-month survival were assessed. Results: A total of 3,674 OHCA patients were included in the analysis. Overall 1-month survival was 2.3% (88/3,674). The Q1 group had the highest 1-month survival (4.6% [42/921]), followed by Q2 (2.7% [25/920]), Q3 (1.1% [11/966]) and Q4 (0.6% [5/867]), respectively (p for trend < 0.001). In the multivariable logistic regression analysis, the proportion of 1-month survival in the Q4 group was significantly lower, compared with that in the Q1 group (adjusted odds ratio 0.23; 95% confidence interval 0.09 to 0.60). The adjusted proportion of 1-month survival decreased in a stepwise manner across increasing quartiles (p for trend <0.001). In a subgroup analysis by initial rhythm, there was a significant interaction (p=0.003) between the rhythms: 1-month survival of OHCA patients presented with a non-shockable rhythm decreased when the lactate levels increased (p for trend < 0.001), but in patients with a shockable rhythm the similar trend was not observed (p for trend = 0.574). Conclusions: The high serum lactate level before ROSC significantly associated with the worse 1-month survival after OHCA. Serum lactate may be one of the effective prognostic indications for OHCA during CPR, especially with non-shockable initial rhythm.

Download Full-text

Association Between Serum Lactate Level During Cardiopulmonary Resuscitation and Survival in Adult Out-of-Hospital Cardiac Arrest: A Multicenter Cohort Study (The Critical Study in Osaka, Japan)

10.21203/rs.3.rs-40098/v1 ◽

2020 ◽

Author(s):

Norihiro Nishioka ◽

Daisuke Kobayashi ◽

Junichi Izawa ◽

Taro Irisawa ◽

Tomoki Yamada ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Lactate Level ◽

Serum Lactate ◽

Critical Study ◽

Multivariable Logistic Regression Analysis ◽

Serum Lactate Level ◽

Shockable Rhythm ◽

Lactate Levels ◽

Hospital Cardiac Arrest

Abstract Background: Serum lactate reflects hypoxic insult in many conditions, but its role as prognostic markers after cardiac arrest is still controversial. This study aimed to investigate the association between serum lactate levels during cardiopulmonary resuscitation (CPR) and survival in patients with out-of-hospital cardiac arrest (OHCA).Methods:We analyzed the data of the Osaka Comprehensive Registry of Intensive Care for OHCA Survival (CRITICAL) study, a prospective multicenter observational study of 14 participating institutions in Osaka Prefecture, Japan that enrolled consecutive OHCA patients. We included adult nontraumatic OHCA patients transported to the hospital with ongoing CPR from 2013 to 2017. Based on the serum lactate levels during CPR, the patients were divided into four quartiles: Q1 (lactate ≤ 10.6 mEq/L), Q2 (10.6 < lactate ≤ 14.1 mEq/L), Q3 (14.1 < lactate ≤ 18.0 mEq/L), and Q4 (lactate > 18.0 mEq/L). The primary outcome of this study was 1-month survival. Results:A total of 11,960 patients were registered and 4,978 of them were eligible for our analyses. The Q1 group had the highest 1-month survival (4.3% [53/1,245]), followed by Q2 (2.5% [31/1,245]), Q3 (1.1% [14/1,328]), and Q4 (0.5% [6/1,160]) groups. In the multivariable logistic regression analysis, the proportion of 1-month survival in the Q4 group was significantly lower than that in the Q1 group (adjusted odds ratio 0.21; 95% confidence interval 0.086 to 0.50). One-month survival decreased in a stepwise manner as the quartiles increased (p for trend <0.001). In subgroup analysis, there was a significant interaction between initial rhythm and survival (p for interaction <0.001); 1-month survival of patients with a non-shockable rhythm decreased when the lactate levels increased (p for trend <0.001), but not in patients with a shockable rhythm (p for trend =0.76).CONCLUSION:High serum lactate level during CPR was associated with poor 1-month survival in OHCA patients. Serum lactate may be one of the effective prognostic indications for OHCA during CPR, especially in patients with non-shockable rhythm.

Download Full-text

Serum Lactate for Predicting Cardiac Arrest in the Emergency Department

Journal of Clinical Medicine ◽

10.3390/jcm11020403 ◽

2022 ◽

Vol 11 (2) ◽

pp. 403

Author(s):

Shu-Hsien Hsu ◽

Po-Hsuan Kao ◽

Tsung-Chien Lu ◽

Chih-Hung Wang ◽

Cheng-Chung Fang ◽

...

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Early Recognition ◽

Multivariable Analysis ◽

Lactate Clearance ◽

Serum Lactate ◽

Increased Risk ◽

Lactate Levels ◽

Hospital Cardiac Arrest ◽

Elevated Lactate

Objectives: Early recognition and prevention of in-hospital cardiac arrest (IHCA) play an increasingly important role in the Chain of Survival. However, clinical tools for predicting IHCA in the emergency department (ED) are scanty. We sought to evaluate the role of serum lactate in predicting ED-based IHCA. Methods: Data were retrieved from 733,398 ED visits over a 7-year period in a tertiary medical centre. We selected one ED visit per person and excluded out-of-hospital cardiac arrest, children, or those without lactate measurements. Patient demographics, computerised triage information, and serum lactate levels were extracted. The initial serum lactate levels were grouped into normal (≤2 mmol/L), moderately elevated (2 < lactate ≤ 4), and highly elevated (>4 mmol/L) categories. The primary outcome was ED-based IHCA. Results: A total of 17,392 adult patients were included. Of them, 342 (2%) developed IHCA. About 50% of the lactate levels were normal, 30% were moderately elevated, and 20% were highly elevated. In multivariable analysis, the group with highly elevated lactate had an 18-fold increased risk of IHCA (adjusted odds ratio [OR], 18.0; 95% confidence interval [CI], 11.5–28.2), compared with the normal lactate group. In subgroup analysis, the poor lactate-clearance group (<2.5%/h) was associated with a 7.5-fold higher risk of IHCA (adjusted OR, 7.5; 95%CI, 3.7–15.1) compared with the normal clearance group. Conclusions: Elevated lactate levels and poor lactate clearance were strongly associated with a higher risk of ED-based IHCA. Clinicians may consider a more liberal sampling of lactate in patients at higher risk of IHCA with follow-up of abnormal levels.

Download Full-text

Transitions Between Circulatory States After Out-of-Hospital Cardiac Arrest: Protocol for an Observational, Prospective Cohort Study (Preprint)

10.2196/preprints.8558 ◽

2017 ◽

Author(s):

Halvor Langeland ◽

Daniel Bergum ◽

Magnus Løberg ◽

Knut Bjørnstad ◽

Jan Kristian Damås ◽

...

Keyword(s):

Cardiac Arrest ◽

Cohort Study ◽

High Resolution ◽

Inflammatory Responses ◽

Superior Vena ◽

Vena Cava ◽

Serum Lactate ◽

Circulatory Failure ◽

State Transitions ◽

Hospital Cardiac Arrest

BACKGROUND The post cardiac arrest syndrome (PCAS) is responsible for the majority of in-hospital deaths following cardiac arrest (CA). The major elements of PCAS are anoxic brain injury and circulatory failure. OBJECTIVE This study aimed to investigate the clinical characteristics of circulatory failure and inflammatory responses after out-of-hospital cardiac arrest (OHCA) and to identify patterns of circulatory and inflammatory responses, which may predict circulatory deterioration in PCAS. METHODS This study is a single-center cohort study of 50 patients who receive intensive care after OHCA. The patients are followed for 5 days where detailed information from circulatory variables, including measurements by pulmonary artery catheters (PACs), is obtained in high resolution. Blood samples for inflammatory and endothelial biomarkers are taken at inclusion and thereafter daily. Every 10 min, the patients will be assessed and categorized in one of three circulatory categories. These categories are based on mean arterial pressure; heart rate; serum lactate concentrations; superior vena cava oxygen saturation; and need for fluid, vasoactive medications, and other interventions. We will analyze predictors of circulatory failure and their relation to inflammatory biomarkers. RESULTS Patient inclusion started in January 2016. CONCLUSIONS This study will obtain advanced hemodynamic data with high resolution during the acute phase of PCAS and will analyze the details in circulatory state transitions related to circulatory failure. We aim to identify early predictors of circulatory deterioration and favorable outcome after CA. CLINICALTRIAL ClinicalTrials.gov: NCT02648061; https://clinicaltrials.gov/ct2/show/NCT02648061 (Archived by WebCite at http://www.webcitation.org/6wVASuOla)

Download Full-text

Association between serum lactate level during cardiopulmonary resuscitation and survival in adult out-of-hospital cardiac arrest: a multicenter cohort study

Scientific Reports ◽

10.1038/s41598-020-80774-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Norihiro Nishioka ◽

◽

Daisuke Kobayashi ◽

Junichi Izawa ◽

Taro Irisawa ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Lactate Level ◽

Serum Lactate ◽

Multivariable Logistic Regression Analysis ◽

Serum Lactate Level ◽

Multicenter Cohort Study ◽

Shockable Rhythm ◽

Lactate Levels ◽

Hospital Cardiac Arrest

AbstractWe aimed to investigate the association between serum lactate levels during cardiopulmonary resuscitation (CPR) and survival in patients with out-of-hospital cardiac arrest (OHCA). From the database of a multicenter registry on OHCA patients, we included adult nontraumatic OHCA patients transported to the hospital with ongoing CPR. Based on the serum lactate levels during CPR, the patients were divided into four quartiles: Q1 (≤ 10.6 mEq/L), Q2 (10.6–14.1 mEq/L), Q3 (14.1–18.0 mEq/L), and Q4 (> 18.0 mEq/L). The primary outcome was 1-month survival. Among 5226 eligible patients, the Q1 group had the highest 1-month survival (5.6% [74/1311]), followed by Q2 (3.6% [47/1316]), Q3 (1.7% [22/1292]), and Q4 (1.0% [13/1307]) groups. In the multivariable logistic regression analysis, the adjusted odds ratio of Q4 compared with Q1 for 1-month survival was 0.24 (95% CI 0.13–0.46). 1-month survival decreased in a stepwise manner as the quartiles increased (p for trend < 0.001). In subgroup analysis, there was an interaction between initial rhythm and survival (p for interaction < 0.001); 1-month survival of patients with a non-shockable rhythm decreased when the lactate levels increased (p for trend < 0.001), but not in patients with a shockable rhythm (p for trend = 0.72). In conclusion, high serum lactate level during CPR was associated with poor 1-month survival in OHCA patients, especially in patients with non-shockable rhythm.

Download Full-text