scholarly journals The prognostic performance of lactate in out of hospital cardiac arrest, a post hoc analysis of the TTM-trial

Author(s):  
Joachim Düring
Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Daniel Rob ◽  
Jana Smalcova ◽  
Tomas Kovarnik ◽  
David Zemanek ◽  
Ales Kral ◽  
...  

Background: An increasing number of cardiac centres are using immediate percutaneous coronary intervention (PCI) and extracorporeal cardiopulmonary resuscitation (ECPR) in patients with refractory out of hospital cardiac arrest (r-OHCA). Published evidence regarding PCI in OHCA has been mainly reporting to patients with early return of spontaneous circulation and the influence of PCI and ECPR on survival in the population of patients with r-OHCA and acute coronary syndrome (ACS) remains unclear. Methods: In this post hoc analysis of the randomized r-OHCA trial, all patients with ACS as a cause of r-OHCA were included. The effect of successful PCI and ECPR on 180-days survival was examined using Kaplan-Meier estimates and multivariable Cox regression. Results: In total, 256 patients were evaluated in Prague OHCA study and 127 (49.6 %) had ACS as the cause of r-OHCA constituting current study population. The mean age was 58 years (46.3-64) and duration of resuscitation was 52.5 minutes (36.5-68). ECPR was used in 51 (40.2 %) of patients. Immediate PCI was performed in 86 (67.7%) patients and TIMI flow 2 or 3 was achieved in 75 (87.2%) patients. The overall 180-days survival of patients with successful PCI was 40 % compared to 7.7 % with no or failed immediate PCI (log-rank p < 0.001). After adjustment for confounders, successful PCI was associated with a lower risk of death (HR 0.47, CI 0.24-0.93, p = 0.031). Likewise, ECPR was associated with a lower risk of death (HR 0.11, CI 0.05-0.24, p< 0.001). Conclusion: In this post hoc analysis of the randomized r-OHCA trial, successful immediate PCI as well as ECPR were associated with improved 180-days survival in patients with r-OHCA due to ACS.


Author(s):  
Humaloja Jaana ◽  
Lähde Marika ◽  
J. Ashton Nicholas ◽  
Reinikainen Matti ◽  
Hästbacka Johanna ◽  
...  

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Johannes Grand ◽  
Christian Hassager ◽  
Matilde Winther-Jensen ◽  
Sebastian Wiberg ◽  
Jakob H Thomsen ◽  
...  

Introduction: Hemodynamic instability is common after resuscitated out-of-hospital cardiac arrest (OHCA). However, data on hemodynamic treatment-goals are sparse. This study investigates mean arterial pressure (MAP) in patients surviving 48 hours after OHCA in relation to organ injury and survival as a post hoc analysis of a large multicenter trial cohort. Hypothesis: We hypothesized that low MAP during TTM was associated with more organ injury. Methods: Post-hoc analysis of the prospective randomized TTM-trial including 851 comatose OHCA patients surviving more than 48 hours with available blood pressure data. Neuron-specific enolase (NSE) (brain injury) was the primary endpoint and estimated glomerular filtration rate (eGFR) (renal function) was the secondary endpoint. Measurements and Main Results: Patients were stratified by mean MAP during TTM in the following groups; <70 mmHg (22%), 70-80 mmHg (43%), and >80 mmHg (35%). NSE at 24, 48 and 72 hours was inversely related to mean MAP: 28 ng/ml [95% confidence interval (CI) 24-33], 26 [23-29], 21 [19-24] ng/mL; p group =0.002 for low, intermediate and high MAP groups. After adjusting for potential confounders, this association remained significant (p group_adjusted =0.006). A similar result was seen for eGFR (p group_adjusted =0.003). Mean MAP was not associated with mortality after 180 days, however higher mean MAP was independently associated with lower odds of renal replacement therapy (odds ratio adjusted = 0.75 [95% CI, 0.63-0.88] per 5 mmHg increase; p < 0.001]) (figure 1). Conclusions: Lower mean MAP during TTM was independently associated with increased biomarkers of brain injury and initiation of renal replacement therapy in a large cohort of comatose OHCA patients. Increasing blood pressure above the guideline-recommended threshold of 65 mmHg during TTM could potentially mitigate organ injury and be renal-protective. This hypothesis should be investigated in prospective trials.


Resuscitation ◽  
2020 ◽  
Vol 151 ◽  
pp. 10-17 ◽  
Author(s):  
Kristian Strand ◽  
Eldar Søreide ◽  
Hans Kirkegaard ◽  
Fabio Silvio Taccone ◽  
Anders Morten Grejs ◽  
...  

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