Serum lactate in refractory out-of-hospital cardiac arrest: Post-hoc analysis of the Prague OHCA study

被引:12
作者
Dusik, Milan [1 ,2 ]
Rob, Daniel [1 ,2 ]
Smalcova, Jana [1 ,2 ]
Havranek, Stepan [1 ,2 ]
Karasek, Jiri [1 ,2 ]
Smid, Ondrej [1 ,2 ]
Brodska, Helena Lahoda [2 ,3 ]
Kavalkova, Petra [1 ,2 ]
Huptych, Michal [4 ]
Bakker, Jan [5 ,6 ,7 ,8 ]
Belohlavek, Jan [1 ,2 ,9 ,10 ]
机构
[1] Charles Univ Prague, Dept Med 2, Dept Cardiovasc Med, Fac Med 1, Prague, Czech Republic
[2] Gen Univ Hosp Prague, Prague, Czech Republic
[3] Charles Univ Prague, Inst Med Biochem & Lab Diagnost, Prague, Czech Republic
[4] Czech Tech Univ, Czech Inst Informat Robot & Cybernet CIIRC, Prague, Czech Republic
[5] Erasmus MC Univ Med Ctr, Rotterdam, Netherlands
[6] NYU Langone, New York, NY USA
[7] Columbia Univ Irving Med Ctr, New York, NY USA
[8] Pontificia Univ Catolica Chile, Santiago, Chile
[9] Charles Univ Prague, Fac Med 1, Dept Cardiovasc Med, Dept Med 2, U Nemocnice 499-2, Prague 12808, Czech Republic
[10] Gen Univ Hosp, U Nemocnice 499-2, Prague 12808, Czech Republic
关键词
CARDIOPULMONARY-RESUSCITATION; SPONTANEOUS CIRCULATION; EUROPEAN RESUSCITATION; BLOOD LACTATE; THERAPEUTIC HYPOTHERMIA; SEVERE SEPSIS; SURVIVAL; ASSOCIATION; COUNCIL; RETURN;
D O I
10.1016/j.resuscitation.2023.109935
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: The severity of tissue hypoxia is routinely assessed by serum lactate. We aimed to determine whether early lactate levels predict outcomes in refractory out-of-hospital cardiac arrest (OHCA) treated by conventional and extracorporeal cardiopulmonary resuscitation (ECPR).Methods: This study is a post-hoc analysis of a randomized Prague OHCA study (NCT01511666) assessing serum lactate levels in refractory OHCA treated by ECPR (the ECPR group) or conventional resuscitation with prehospital achieved return of spontaneous circulation (the ROSC group). Lactate concentrations measured on admission and every 4 hours (h) during the first 24 h were used to determine their relationship with the neurological outcome (the best Cerebral Performance Category score within 180 days post-cardiac arrest).Results: In the ECPR group (92 patients, median age 58.5 years, 83% male) 26% attained a favorable neurological outcome. In the ROSC group (82 patients, median age 55 years, 83% male) 59% achieved a favorable neurological outcome. In ECPR patients lactate concentrations could dis-criminate favorable outcome patients, but not consistently in the ROSC group. On admission, serum lactate >14.0 mmol/L for ECPR (specificity 87.5%, sensitivity 54.4%) and >10.8 mmol/L for the ROSC group (specificity 83%, sensitivity 41.2%) predicted an unfavorable outcome.Conclusion: In refractory OHCA serum lactate concentrations measured anytime during the first 24 h after admission to the hospital were found to correlate with the outcome in patients treated by ECPR but not in patients with prehospital ROSC. A single lactate measurement is not enough for a reliable outcome prediction and cannot be used alone to guide treatment.
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页数:8
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共 44 条
[1]   Intraarrest transport, extracorporeal cardiopulmonary resuscitation, and early invasive management in refractory out-of-hospital cardiac arrest: an individual patient data pooled analysis of two randomised trials [J].
Belohlavek, Jan ;
Yannopoulos, Demetris ;
Smalcova, Jana ;
Rob, Daniel ;
Bartos, Jason ;
Huptych, Michal ;
Kavalkova, Petra ;
Kalra, Rajat ;
Grunau, Brian ;
Taccone, Fabio Silvio ;
Aufderheide, Tom P. .
ECLINICALMEDICINE, 2023, 59
[2]   Effect of Intra-arrest Transport and Extracorporeal Cardiopulmonary Resuscitation on Functional Neurologic Outcome in Refractory Out-of-Hospital Cardiac Arrest Reply [J].
Belohlavek, Jan ;
Rob, Daniel ;
Smalcova, Jana .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2022, 327 (23) :2357-2357
[3]   Hyperinvasive approach to out-of hospital cardiac arrest using mechanical chest compression device, prehospital intraarrest cooling, extracorporeal life support and early invasive assessment compared to standard of care. A randomized parallel groups comparative study proposal. "Prague OHCA study" [J].
Belohlavek, Jan ;
Kucera, Karel ;
Jarkovsky, Jiri ;
Franek, Ondrej ;
Pokorna, Milana ;
Danda, Jiri ;
Skripsky, Roman ;
Kandrnal, Vit ;
Balik, Martin ;
Kunstyr, Jan ;
Horak, Jan ;
Smid, Ondrej ;
Valasek, Jaroslav ;
Mrazek, Vratislav ;
Schwarz, Zdenek ;
Linhart, Ales .
JOURNAL OF TRANSLATIONAL MEDICINE, 2012, 10
[4]   Using initial serum lactate level in the emergency department to predict the sustained return of spontaneous circulation in nontraumatic out-of-hospital cardiac arrest patients [J].
Dadeh, Ar-aishah ;
Nuanjaroan, Banjaparat .
OPEN ACCESS EMERGENCY MEDICINE, 2018, 10 :105-111
[5]   Time of on-scene resuscitation in out of-hospital cardiac arrest patients transported without return of spontaneous circulation [J].
de Graaf, Corina ;
Beesems, Stefanie G. ;
Koster, Rudolph W. .
RESUSCITATION, 2019, 138 :235-242
[6]   Prognostic implications of blood lactate concentrations after cardiac arrest: a retrospective study [J].
Dell'Anna, Antonio Maria ;
Sandroni, Claudio ;
Lamanna, Irene ;
Belloni, Ilaria ;
Donadello, Katia ;
Creteur, Jacques ;
Vincent, Jean-Louis ;
Taccone, Fabio Silvio .
ANNALS OF INTENSIVE CARE, 2017, 7
[7]   Effective lactate clearance is associated with improved outcome in post-cardiac arrest patients [J].
Donnino, Michael W. ;
Miller, Joseph ;
Goyal, Nikhil ;
Loomba, Manisha ;
Sankey, Steadman S. ;
Dolcourt, Bram ;
Sherwin, Robert ;
Otero, Ronny ;
Wira, Charles .
RESUSCITATION, 2007, 75 (02) :229-234
[8]   Initial Lactate and Lactate Change in Post-Cardiac Arrest: A Multicenter Validation Study [J].
Donnino, Michael W. ;
Andersen, Lars W. ;
Giberson, Tyler ;
Gaieski, David F. ;
Abella, Benjamin S. ;
Peberdy, Mary Anne ;
Rittenberger, Jon C. ;
Callaway, Clifton W. ;
Ornato, Joseph ;
Clore, John ;
Grossestreuer, Anne ;
Salciccioli, Justin ;
Cocchi, Michael N. .
CRITICAL CARE MEDICINE, 2014, 42 (08) :1804-1811
[9]   How effective is extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest? A systematic review and meta-analysis [J].
Downing, Jessica ;
Al Falasi, Reem ;
Cardona, Stephanie ;
Fairchild, Matthew ;
Lowie, Bobbi ;
Chan, Caleb ;
Powell, Elizabeth ;
Pourmand, Ali ;
Tran, Quincy K. .
AMERICAN JOURNAL OF EMERGENCY MEDICINE, 2022, 51 :127-138
[10]   Survival rates in out-of-hospital cardiac arrest patients transported without prehospital return of spontaneous circulation: An observational cohort study [J].
Drennan, Ian R. ;
Lin, Steve ;
Sidalak, Daniel E. ;
Morrison, Laurie J. .
RESUSCITATION, 2014, 85 (11) :1488-1493