Better lactate clearance associated with good neurologic outcome in survivors who treated with therapeutic hypothermia after out-of-hospital cardiac arrest
Open Access
- 1 January 2013
- journal article
- research article
- Published by Springer Science and Business Media LLC in Critical Care
- Vol. 17 (5), R260
- https://doi.org/10.1186/cc13090
Abstract
Several 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. This 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. Out 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 P P 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 P = 0.02). The lactate clearance rate, and not the initial lactate level, was associated with neurological outcome in OHCA patients after therapeutic hypothermia.Keywords
This publication has 35 references indexed in Scilit:
- Management of the Post-cardiac Arrest SyndromeThe Journal of Emergency Medicine, 2012
- Predictors of Survival From Out-of-Hospital Cardiac ArrestCirculation: Cardiovascular Quality and Outcomes, 2010
- Post-cardiac arrest syndrome: Epidemiology, pathophysiology, treatment, and prognostication: A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on StrokeResuscitation, 2008
- Metabolic Impact of Shivering During Therapeutic Temperature ModulationStroke, 2008
- Postresuscitation disease after cardiac arrest: a sepsis-like syndrome?Current Opinion in Critical Care, 2004
- Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac ArrestThe New England Journal of Medicine, 2002
- Treatment of Comatose Survivors of Out-of-Hospital Cardiac Arrest with Induced HypothermiaThe New England Journal of Medicine, 2002
- Effect of temperature on the kinetics of lactate production and clearance in a rat model of forebrain ischemiaBiochemistry and Cell Biology, 1998
- Blood pressure and arterial lactate level are early indicators of short-term survival in human septic shockIntensive Care Medicine, 1996
- ASSESSMENT OF OUTCOME AFTER SEVERE BRAIN DAMAGE A Practical ScaleThe Lancet, 1975