Abstract 264: Out-of-Hospital Cardiac Arrest: The Cumulative Effect of Bystander Cardiopulmonary Resuscitation, Automated External Defibrillator and Automated Load Distributing Band Device Use on Return of Spontaneous Circulation

2012 ◽  
Vol 111 (suppl_1) ◽  
Author(s):  
Nabil El Sanadi ◽  
Todd Leduc ◽  
Gabriel Thornton ◽  
David Erdman ◽  
Jason Mansour ◽  
...  
Keyword(s):  
Cumulative Effect ◽  
Spontaneous Circulation ◽  
Essential Elements ◽  
High Rate ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Initial Rhythm ◽  
Chain Of Survival ◽  
Device Use ◽  
Data Elements ◽  
Hospital Cardiac Arrest

Introduction : Early bystander C.P.R., A.E.D. use and continuous chest compressions are essential elements of the a.h.a. “chain of survival”. Bystander C.P.R. and A.E.D. use in urban settings are becoming more prevalent. The use of an automated load distributing band (l.d.b.) device for O.H.C.A. management in a large metropolitan area by paramedics was implemented in the winter of 2007; in 9 municipalities, 582 paramedics were trained to use the l.d.b. device as part of a.l.s. measures. A retrospective paramedic “run-sheet” review was performed from 4/2008 - 8/2009 for all nontraumatic adult cardiac arrests. R.O.S.C. on arrival to the emergency departments (e.d.) was the endpoint. Methods: 86 adult nontraumatic O.H.C.A. rehorts were found. each of the prehospital reports were reviewed. Utstein data elements were collected. bystander C.P.R. with “caller-aided” dispatch, A.E.D. use, paramedic use of standard a.h.a. resuscitation alogarthythms in addition to use of an automated l.d.b. device use (auto pulse® zoll) was recorded. Minitab 15 statistical software was used to evaluate the data. The cumulative effect of sequential “chain-of-survival” components was calculated. Results: the mean age was 63 Y.O.; there were 58 males and 28 females. The initial rhythm was: v.fib, pulseless v.tach, P.E.A., or asystole. Chain of survival cumulative synergistic effect on R.O.S.C. Conclusion: When bystander C.P.R., in addition to A.E.D. and autopulse were utilized synegistically, R.O.S.C. on e.d. arrival was 71%. When bystander C.P.R. and autopulse were used (without A.E.D. use) only 49% of patients had R.O.S.C. on e.d. arrival. Which is higher than previously reported: Hallstrom et al. (2006): 26% and Ong et al. (2006): 35%. When the l.d.b. device was used with a.l.s., R.O.S.C. was only 20%; which may be due to delayed care; since no efforts were made to resuscitate patients until the paramedics arrived. Our data reaffirms that early bystander C.P.R. and A.E.D. use are essential for achieving a high rate of R.O.S.C.

scholarly journals Drowning: an overlooked cause of out-of-hospital cardiac arrest in Canada

CJEM ◽  
2014 ◽  
Vol 16 (04) ◽  
pp. 314-321 ◽  
Author(s):  
Jason E. Buick ◽  
Steve Lin ◽  
Valeria E. Rac ◽  
Steven C. Brooks ◽  
Gérald Kierzek ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Response Times ◽  
Spontaneous Circulation ◽  
Public Access ◽  
Health Concern ◽  
Bivariate Analysis ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

ABSTRACT Introduction: Drowning is a major public health concern, yet little is known about the characteristics of drowning patients. The objectives of this study were to describe the demographic and clinical characteristics of out-of-hospital cardiac arrest (OHCA) attributed to drowning in Ontario and to compare the characteristics of OHCA attributed to drowning to those of presumed cardiac etiology. Methods: A retrospective, observational study was carried out of consecutive OHCA patients of drowning etiology in Ontario between August 2006 and July 2011. Bivariate analysis was used to evaluate differences between drowning and presumed cardiac etiologies. Results: A total of 31,763 OHCA patients were identified, and 132 (0.42%) were attributed to drowning. Emergency medical services treated 98 patients, whereas the remaining 34 met the criteria for legislative death. Overall, 5.1% of drowning patients survived to hospital discharge. When compared to patients of presumed cardiac etiology, drowning patients were younger and their arrest was more likely to be unwitnessed, present with a nonshockable initial rhythm, occur in a public location, and receive bystander cardiopulmonary resuscitation (CPR). A nonsignificant trend was noted for drowning cases to more frequently have a public access AED applied. There were no significant differences in the gender ratio or paramedic response times. Drowning patients were more likely to be transported to hospital but had a trend to be less likely to arrive with a return of spontaneous circulation. They were also more likely to be admitted to hospital but had no difference in survival to hospital discharge. Conclusions: Significant differences exist between OHCA of drowning and presumed cardiac etiologies. Most drownings are unwitnessed, occur in public locations, and present with nonshockable initial rhythms, suggesting that treatment should focus on bystander CPR. Future initiatives should focus on strategies to improve supervision in targeted locations and greater emphasis on bystander-initiated CPR, both of which may reduce drowning mortality.

Abstract 325: Characteristics and Outcomes of Hanging Induced Out-Of-Hospital Cardiac Arrest: Insights From the Paris Sudden Death Expertise Center Registry

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Arnaud Gille ◽  
Richard Chocron ◽  
Anna Ozguler ◽  
Xavier JOUVEN ◽  
Alain Cariou ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Spontaneous Circulation ◽  
Low Flow ◽  
Flow Duration ◽  
Shockable Rhythm ◽  
Younger Age ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

Introduction: Hanging-induced Out-of-Hospital cardiac arrest (OHCA) is poorly studied and a better understanding of these specific OHCA could be helpful to improve patients’ outcome. The main objective of our study was to describe characteristics and outcomes in patients who had OHCA from hanging injuries. Methods: From May 2011 to December 2017 we analyzed a prospectively collected Utstein database for all OHCA adults. All cases due to hanging were included. Utstein style variables were compared for 2 groups of patients: those with a Return of Spontaneous Circulation (ROSC) and those without (non-ROSC). Continuous data are described as means (extremes). Results: Among 25 055 OHCA, 500 patients were included. They were 49 (18-100) years old. Seventy-three (14.6%) hanging were witnessed and 58 (11.6%) benefited from a bystander cardiopulmonary resuscitation before Emergency Medical Service (EMS) arrival. No-flow duration was 29.1 (4-180) minutes. Advance life support was initiated by EMS in 299 (59.8%) cases. Low-flow duration was 23.8 (2-79) minutes. Nine patients (1.8%) had a shockable initial rhythm. We observed 83 (16.6%) ROSC. Four (0.8%) patients were discharged alive from hospital. They were all CPC 1. Table 1 compares characteristics with significant differences between ROSC and non-ROSC groups. Conclusion: As expected, younger age, short no-flow and low-flow durations and shockable rhythm on EMS arrival were significantly associated with ROSC. Overall prognosis is dramatically poor when OHCA is due to hanging (<1%), with a very low proportion of shockable rhythm, even if the rare survivors have an excellent CPC at discharge. Indeed, the best method to reduce the mortality rate of hanging is, with no contest, the prevention of suicidal act.

Abstract 141: Resuscitation Time Bias in an Observational Study of Mechanical Chest Compression CPR

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Michael K Levy ◽  
Karl B Kern ◽  
Dana Yost ◽  
Bjarne Madsen Hardig ◽  
Fred W Chapman
Keyword(s):  
Cardiac Arrest ◽  
Observational Studies ◽  
Spontaneous Circulation ◽  
Prolonged Treatment ◽  
Device Application ◽  
Group Response ◽  
Device Use ◽  
One Year ◽  
Mechanical Cpr ◽  
Hospital Cardiac Arrest

Recent observational studies have found associations between poorer outcomes and treatment that included mechanical CPR devices, contradicting findings from randomized trials. Resuscitation time bias is a systematic error occurring in observational studies of interventions applied to pulseless patients later in resuscitation attempts. Previous observational studies lack data on duration of resuscitation, a factor strongly related to outcome. We retrospectively analyzed cardiac arrest data to learn how resuscitation time and device use relate to clinical outcomes, and determine whether resuscitation time bias was present. Methods and Results: We analyzed data from all 49 patients with ventricular fibrillation, out-of-hospital cardiac arrest treated by our emergency medical service in one year. We compared 19 patients who received only standard manual CPR (the sCPR group) to 30 patients who received manual followed by mechanical CPR (the mCPR group). Response to CPR differed between groups even before device application. All sCPR patients achieved return of spontaneous circulation (ROSC), and did so after a median (IQR) of 3.3 (2.2-5.1) minutes of manual CPR. Patients in the mCPR group failed to get ROSC through 6.9 (5.3-11.0) min of manual CPR; mCPR patients that did get ROSC did so after 11.2 (5.7-23.8) additional minutes of CPR, delivered by a mechanical device. mCPR patients also received significantly more defibrillations and ALS drugs. ROSC and survival to hospital discharge were higher in the sCPR than the mCPR group (100% vs. 70%, P = 0.008; 74% vs. 43%, P = 0.045). Conclusion: Only patients remaining pulseless after early resuscitation efforts received mechanical CPR. Consequently, mechanical CPR devices assisted by facilitating prolonged treatment of patients who already had lower chances of survival before device application. Resuscitation time bias was present, and must be considered when interpreting registry reports comparing sCPR and mCPR.

Abstract 18070: Therapies Optimizing Organ Perfusion and Protection After Out-of-hospital Cardiac Arrest Improves Survival With Favorable Neurologic Outcome

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Michael J Jacobs ◽  
Leo S Derevin ◽  
Sue Duval ◽  
James E Pointer ◽  
Karl A Sporer
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Outcome Data ◽  
Neurological Function ◽  
Inverse Association ◽  
Advanced Airway ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

Introduction: Survival rates with favorable neurologic function after out-of-hospital cardiac arrest (OHCA) have remained low for decades. Hypothesis: Use of therapies focused on better perfusion during CPR using mechanical adjuncts and protective post-resuscitation care would improve survival and neurologic outcomes after OHCA compared to conventional CPR and care. Methods: OHCA outcomes in Alameda County, CA, USA, population 1.5 million, from December 2009-2011 when there was incomplete availability and use of impedance threshold device [ITD], mechanical CPR [MCPR], and hospital therapeutic hypothermia [HTH], were compared to 2012 when all were available and more widely used. Return of Spontaneous Circulation (ROSC), survival and Cerebral Performance Category (CPC) scores were compared using univariate and multivariable analyses. Results: Of the 3008 non-traumatic OHCAs who received CPR during the study period, >95% of survival outcome data were available. From 2009-11 to 2012, there was an increase in ROSC from 28.6% to 34.1% (p=0.002; OR=1.28; CI=1.09, 1.51) and a non-significant increase in hospital discharge from 10.5% to 12.3% (p=0.14; OR=1.17; CI=0.92, 1.49). There was, however, an 80% increase in survival with favorable neurological function between the two periods, as determined by CPC≤2, from 4.4% to 7.9% (p<0.001; unadjusted OR=1.85; CI=1.35, 2.54). After adjusting for witnessed arrest, bystander CPR, initial rhythm (VT/VF vs. others), placement of an advanced airway, EMS response time, and age, the adjusted OR was 1.60 (1.11, 2.31; p=0.012). Using a stepwise regression model, the most important independent positive predictors of CPC≤2 were 2012 (p=0.019), witnessed (p<0.001), initial rhythm VT/VF (p<0.001), and advanced airway (inverse association p<0.001). Additional analyses of the three therapies, separately and in combination, demonstrated that for all patients admitted to the hospital, ITD use with HTH had the most impact on survival to discharge with CPC≤2 of 24%. Conclusions: Therapies (ITD, MCPR, HTH) developed to enhance circulation during CPR and cerebral recovery after ROSC, significantly improved survival with favorable neurological function by 80% following OHCA.

scholarly journals The influence of past experiences on future willingness to perform bystander cardiopulmonary resuscitation

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Keng Sheng Chew ◽  
Shazrina Ahmad Razali ◽  
Shirly Siew Ling Wong ◽  
Aisyah Azizul ◽  
Nurul Faizah Ismail ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Hospital Setting ◽  
Spontaneous Circulation ◽  
Cardiac Events ◽  
Validated Questionnaire ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Past Experiences ◽  
Hospital Cardiac Arrest

Abstract Background The influence of past familial experiences of receiving cardiopulmonary resuscitation (CPR) and medical help in various cardiac arrest and nonfatal cardiac events toward willingness to “pay it forward” by helping the next cardiac arrest victim was explored. Methods Using a validated questionnaire, 6248 participants were asked to rate their willingness to perform bystander chest compression with mouth-to-mouth ventilation and chest compression-only CPR. Their past familial experiences of receiving cardiopulmonary resuscitation (CPR) and medical help in various cardiac arrest and nonfatal cardiac events were also recorded. Results Kruskal-Wallis test with post hoc Dunn’s pairwise comparisons showed that the following were significantly more willing to perform CPR with mouth-to-mouth ventilation: familial experience of “nonfatal cardiac events” (mean rank = 447) vs “out-of-hospital cardiac arrest with no CPR” (mean rank = 177), U = 35442.5, z = −2.055, p = 0.04; “in-hospital cardiac arrest and successful CPR” (mean rank = 2955.79) vs “none of these experiences” (mean rank = 2468.38), U = 111903, z = −2.60, p = 0.01; and “in-hospital cardiac arrest with successful CPR” (mean rank = 133.45) vs “out-of-hospital arrest with no CPR” (mean rank = 112.36), U = 4135.5, z = −2.06, p = 0.04. For compression-only CPR, Kruskal-Wallis test with multiple runs of Mann-Whitney U tests showed that “nonfatal cardiac events” group was statistically higher than the group with “none of these experiences” (mean rank = 3061.43 vs 2859.91), U = 1194658, z = −2.588, p = 0.01. The groups of “in-hospital cardiac arrest with successful CPR” and “in-hospital cardiac arrest with transient return of spontaneous circulation” were the most willing groups to perform compression-only CPR. Conclusion Prior familial experiences of receiving CPR and medical help, particularly among those with successful outcomes in a hospital setting, seem to increase the willingness to perform bystander CPR.

End-Tidal CO2 as a Predictor of Survival in Out-of-Hospital Cardiac Arrest

2011 ◽  
Vol 26 (3) ◽  
pp. 148-150 ◽  
Author(s):  
Marc Eckstein ◽  
Lorien Hatch ◽  
Jennifer Malleck ◽  
Christian McClung ◽  
Sean O. Henderson
Keyword(s):  
Cardiac Arrest ◽  
Los Angeles ◽  
Spontaneous Circulation ◽  
Outcome Variable ◽  
Primary Outcome Variable ◽  
Return Of Spontaneous Circulation ◽  
Bystander Cardiopulmonary Resuscitation ◽  
The Mean ◽  
End Tidal ◽  
Hospital Cardiac Arrest

AbstractObjective: The objective of this study was to evaluate initial end-tidal CO2 (EtCO2) as a predictor of survival in out-of-hospital cardiac arrest.Methods: This was a retrospective study of all adult, non-traumatic, out-of-hospital, cardiac arrests during 2006 and 2007 in Los Angeles, California. The primary outcome variable was attaining return of spontaneous circulation (ROSC) in the field. All demographic information was reviewed and logistic regression analysis was performed to determine which variables of the cardiac arrest were significantly associated with ROSC.Results: There were 3,121 cardiac arrests included in the study, of which 1,689 (54.4%) were witnessed, and 516 (16.9%) were primary ventricular fibrillation (VF). The mean initial EtCO2 was 18.7 (95%CI = 18.2–19.3) for all patients. Return of spontaneous circulation was achieved in 695 patients (22.4%) for which the mean initial EtCO2 was 27.6 (95%CI = 26.3–29.0). For patients who failed to achieve ROSC, the mean EtCO2 was 16.0 (95%CI = 15.5–16.5). The following variables were significantly associated with achieving ROSC: witnessed arrest (OR = 1.51; 95%CI = 1.07–2.12); initial EtCO2 >10 (OR = 4.79; 95%CI = 3.10–4.42); and EtCO2 dropping <25% during the resuscitation (OR = 2.82; 95%CI = 2.01–3.97).The combination of male gender, lack of bystander cardiopulmonary resuscitation, unwitnessed collapse, non-vfib arrest, initial EtCO2 ≤10 and EtCO2 falling > 25% was 97% predictive of failure to achieve ROSC.Conclusions: An initial EtCO2 >10 and the absence of a falling EtCO2 >25% from baseline were significantly associated with achieving ROSC in out-of-hospital cardiac arrest. These additional variables should be incorporated in termination of resuscitation algorithms in the prehospital setting.

scholarly journals Just the Facts: Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest

CJEM ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 760-763
Author(s):  
Shannon M. Fernando ◽  
Brian Grunau ◽  
Daniel Brodie
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Tertiary Care ◽  
Spontaneous Circulation ◽  
Tertiary Care Centre ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
St Segment Elevation ◽  
St Segment ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

A 58-year-old man is brought by the ambulance to the emergency department (ED) of a tertiary care centre following an out-of-hospital cardiac arrest. Paramedics were called by the patient's wife after he had collapsed. She immediately initiated cardiopulmonary resuscitation (CPR). Prior to his collapse, he had been complaining of chest pain. His initial rhythm in the field was ventricular fibrillation, and he received defibrillation. An automated CPR device was applied prior to transport. En route, return of spontaneous circulation is achieved. An electrocardiogram shows ST-segment elevation in the anterior leads. Just prior to arrival, the patient suffers recurrent cardiac arrest with two further rounds of unsuccessful defibrillation in the ED. At this point, a decision is made to proceed with extracorporeal cardiopulmonary resuscitation (ECPR), prior to transport for cardiac catheterization.

Resuscitation for Patients with Out-of-Hospital Cardiac Arrest: Singapore

2002 ◽  
Vol 17 (2) ◽  
pp. 96-101 ◽  
Author(s):  
Ghee Hian Lim ◽  
Eillyne Seow
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Hospital Setting ◽  
Pulseless Electrical Activity ◽  
Spontaneous Circulation ◽  
Very High Frequency ◽  
Traumatic Cardiac Arrest ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Hospital Cardiac Arrest ◽  
Very High

AbstractAim:To evaluate characteristics and outcome of out-of-hospital cardiac arrest (OHCA) patients presenting to the Emergency Department (ED), and to examine factors that could be used to determine to prolong or abort resuscitation for these patients.Method:All OHCA patients presenting to the ED were studied over a three-month period from November 2001 through January 2002. Patient with traumatic cardiac arrest were excluded. Data were collected from the ambulance case records, ED resuscitation charts, and the ED Very High Frequency (VHF) radio case-log sheet. Information collected included the patient's demographic characteristics, timings (time from call to ambulance arrival on scene, time from arrival at scene to departure from scene, time from scene to arrival in the ED) recorded in the pre-hospital setting, the outcome of the resuscitation, and the final outcome for patients who survived ED resuscitation.Results:Ninety-three non-traumatic patients with an OHCA were studied during the three-month period. Of the 93 patients, 15 (16.1%) survived ED resuscitation, and one survived to hospital discharge. There were no statistically significant differences for age, race, or gender with regards to the outcome of the resuscitation. The initial cardiac rhythms were asystole (65), pulseless electrical activity (21), and ventricular fibrillation (7). Fourteen (15%) received bystander cardiopulmonary resuscitation (CPR). All seven patients with return of spontaneous circulation (ROSC) on arrival in the ED survived ED resuscitation. The ambulance took an average of 11.80 ±3.36 minutes for the survivors and 11.8 ±4.22 minutes for the non-survivors from the time of call to get to these patients. The average of the scene times was 12.5 ±4.61 minutes for the survivors and 12.0 ±4.02 minutes for the non-survivors. Transport time from the scene to the ED took an average of 39.1 ±8.32 minutes for the survivors and 37.2 ±9.00 minutes for the non-survivors.Conclusion:The survival rate for patients with OHCA after ED resuscitation is similar to the results from other studies. There is a need to increase the awareness and delivery of basic life support by public education. Automatic External Defibrillators (AED) should be available widely to ensure that the chance of early defibrillation is increased. Prolonged resuscitation efforts appear to be futile for OHCA patients if the time from cardiac arrest until arrival in the ED is ≥30 minutes coupled with no ROSC, and if continuous asystole has been documented for >10 minutes.

Abstract 138: Defining System of Care Best Practices for Out-Of-Hospital Cardiac Arrest Survival

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Mahshid Abir ◽  
Timothy C Guetterman ◽  
Sydney Fouche ◽  
Samantha Iovan ◽  
Jessica L Lehrich ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Best Practices ◽  
Prehospital Care ◽  
Critical Role ◽  
Spontaneous Circulation ◽  
High Survival ◽  
Factors Associated ◽  
Defining System ◽  
Chain Of Survival ◽  
Hospital Cardiac Arrest

Introduction: EMS system factors key to improved survival for out-of-hospital cardiac arrest (OHCA) have not been well elucidated. This study explores factors associated with sustained return of spontaneous circulation (ROSC) in the field with pulse upon arrival to the ED-a measure of high quality of prehospital care-across the chain of survival. Methods: This sequential mixed methods study used data from the Michigan Cardiac Arrest Registry to Enhance Survival (MI-CARES) to evaluate variation in OHCA outcomes across EMS agencies. Sites were sampled based on geography, rurality, population density, and survival rate. We visited 1 low-, 1 middle-, and 3 high-survival EMS systems. At each site, we conducted key informant interviews with field staff, mid-level managers, and leadership from EMS, police, fire, and dispatch, as well as multidisciplinary focus groups. Transcripts were coded using a structured codebook and analyzed using thematic analysis. Results: An integrated multidisciplinary approach was critical for timely OHCA care coordination across the chain of survival. Themes that emerged across all stakeholders included: 1) OHCA education and multidisciplinary training; 2) shared awareness of roles in the chain of survival and system-wide response; 4) multidisciplinary QI; and 5) leadership and initiative (Table 1). Conclusions: Recognizing the critical role of each level in the chain of survival, this study identified specific practices from EMS system stakeholders that were associated with improved survival. The next phase of this work will include validating the factors associated with increased survival identified through a statewide survey of EMS agencies in Michigan. The final product of this work will include a toolkit of best practices and an implementation guide.

Abstract 110: Lactate and Hypotension as Predictors of Mortality After In-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Mahmoud S Issa ◽  
Tuyen Yankama ◽  
Het Patel ◽  
Lethu Ntshinga ◽  
Amin Coker ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Spontaneous Circulation ◽  
P Value ◽  
Predictors Of Mortality ◽  
Prediction Of Mortality ◽  
Initial Rhythm ◽  
Parsimonious Model ◽  
Hospital Cardiac Arrest ◽  
Elevated Lactate ◽  
Elevated Lactate Level

Background: In hospital cardiac arrest (IHCA) affects >290,000 people in USA annually. Although there are many differences between IHCA and out of hospital cardiac arrest (OHCA), the bulk of data used to guide management comes from OHCA studies. Prediction of mortality after IHCA could be useful in making decisions around post-arrest care. We hypothesized that elevated lactate and the need for vasopressor support after arrest would predict mortality in an IHCA population. Methods: Retrospective single-center observational study of all adult IHCA patients with sustained return of spontaneous circulation (ROSC), lactate within 2 hrs of ROSC, and intubated pre-arrest or within 1 hr after, from 2008 - 2018. Multivariable logistic regression was used to evaluate the association of post-ROSC lactate and need for vasopressors, as well as other covariates, with mortality. Backwards selection was used to determine the most parsimonious model. Results: Of 541 patients; 364 met criteria and were included. Overall mortality was 56%. The distributions of initial rhythm, pre-arrest vasopressor and pre-arrest mechanical ventilation were similar between groups. Patients who received vasopressors within 3 hrs of ROSC had higher mortality compared to patients who did not (58% vs. 43%, p-value 0.04). Elevated lactate level was also associated with mortality (44% if < 5 mmol/L, 58% if 5 - 10 mmol/L, and 73% if ≥10 mmol/L, p-value<0.01). Mortality in those with lactate <5 and no vasopressors was 33%, compared to 75% in those with lactate >10 and need for vasopressors (p<0.01). The most parsimonious predictive model included lactate, post-arrest vasopressor, age, arrest location, and pre-arrest diagnosis (AUC 0.68 [95 CI: 0.63-0.74]). Conclusion: Post-ROSC lactate and need for vasopressor were useful predictors of mortality, although AUC was lower than what has been reported in OHCA studies. Development of a more discriminating tool would be valuable to clinicians and in IHCA research.

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