Lactate and hypotension as predictors of mortality after in-hospital cardiac arrest

Issa, Mahmoud S; Grossestreuer, Anne V.; Patel, Hemant; Ntshinga, Lethu; Coker, Amin; Yankama, Tuyen; Donnino, Michael W.; Berg, Katherine M.

doi:10.1016/j.resuscitation.2020.10.018

Cited by 31 publications

(25 citation statements)

References 17 publications

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“…In addition, lactate and potassium levels were significantly different between the survivor and nonsurvivor groups. In a study about mortality predictors after ROSC [20], lactate levels in nonsurvivor IHCA patients were revealed to be 2 units lower, with a value of 7.2 mmol/L (4.4-10.1), than that of the patient group in our study.…”

Section: Discussioncontrasting

confidence: 58%

Outcomes of arrest patients resuscitated in an emergency department: a prospective, observational study

2021

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In developing countries, a lack of knowledge about basic life support and overcrowded emergency departments (EDs) may cause problems related to the quality of cardiopul-monary resuscitation and postresuscitation care. We aimed to investigate which factors affect the return of spontaneous circulation (ROSC) and survival rates among out-of-hospital and in-hospital arrest patients in an upper-middle income country. The study was prospectively conducted from January 2018 to April 2019. All patients resuscitated in the ED, except trauma patients, were included. The out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) groups were followed up for 30 days. The primary outcome was the 30-day-survival rate, while the secondary outcome was the ROSC rate. A total of 177 patients were included in the study (80 OHCA and 97 IHCA patients). Among the OHCA patients, ROSC was achieved at a rate of 58.8%, and a 30-day survival rate of 12.5% was observed. None of the OHCA patients underwent bystander CPR. One of the main factors affecting survival in this group was the time interval until the patient reached the ED. ROSC was achieved in 54.4% of IHCA patients, while 17.5% of them were alive at 30 days. Patients who survived 30 days were significantly younger than those who died within 30 days (56 (46–74) vs. 73 (64.2–83.7) years, respectively). In the IHCA group, patients with creatinine and potassium levels closer to normal survived for 30 days. Effective and rapid fluid-electrolyte treatments of patients with high lactate and potassium levels may improve the mortality rates of these patients. We think that a focus on improving the quality of the prehospital CPR practice in OHCA patients and increasing the rates of bystander CPR by educating the public can positively contribute to outcomes.

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Section: Discussioncontrasting

confidence: 58%

Outcomes of arrest patients resuscitated in an emergency department: a prospective, observational study

2021

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“…Lactate is the end product of anaerobic metabolism that can be used as a marker of cellular hypoxia and to predict mortality in critical illness 34 . Previous investigations have proved the utility of lactate as a marker for disturbances of tissue perfusion to predict survival in cardiac arrest patients 35,36 . According to our results, the lactate values per se had moderate prognostic value for 30-day mortality compared to the ones of SOFA and SAPS II.…”

Section: Discussionmentioning

confidence: 99%

“…Similar to their results in our population the cut-off was 4.90 mmol/L to predict 30-day mortality and 6.00 mmol/L for poor neurological prognosis. A most recent publication emphasised the need for development of prognostication tool in IHCA 36 . They retrospectively investigated the predictive role of the initial lactate levels among patients who suffered IHCA and required mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

Investigating Novel and Conventional Biomarkers for Post-resuscitation Prognosis: The Role of Cytokeratin-18, Neuron-specific Enolase, and Lactate

Csiszar¹,

Nemeth²,

Márton³

et al. 2021

Preprint

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Introduction: We investigated the associations of cell death-related release of cytokeratin-18 (CK-18) and its caspase-cleaved form (CCCK-18) with outcomes, clinical parameters, and neuron-specific enolase (NSE) among cardiac arrest (CA) victims.Methods: We determined CK-18, CCCK-18, and NSE plasma concentrations within 6, at 24, and 72 post-CA hours of 54 successfully resuscitated patients. Baseline characteristics, laboratory, vital parameters, prognostic scores were recorded. The follow-up was 30 days.Results: Neither the absolute values of CK-18, CCCK-18, CCCK-18/CK-18 ratio, or NSE, nor their kinetics showed significant difference according to survival and neurological outcome. CK-18 decreased in good renal function in contrast to renal failure. Lactate levels were increased in non-survivors and poor neurological outcomes. In receiver operator characteristic (ROC) analyses lactate was comparable with prognostic scores in predicting 30-day mortality and neurological outcome. The ROC curve of initial lactate indicated a cut-off as 4.90 mmol/L to predict 30-day mortality (specificity=80%; sensitivity=74%) and 6.00 mmol/L (specificity=80%; sensitivity=84%) for poor neurological outcome.Conclusion: This study was the first to investigate the post-resuscitation prognostic value of CK-18 and CCCK-18 with NSE. Although we could not prove their prognostic value, we confirmed the role of initial lactate in predicting mortality and neurological outcome in unselected resuscitated patients.

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“…It has to be noted that the clinical signs are not specific to PCAS and do not allow physician to determine the PCAS phenotype (vasoplegia predominant or cardiogenic predominant). Regarding biological parameters assessing tissue hypoxia, first high lactate level is associated to worsen prognosis, but lactate levels alone do not involve therapeutic management modifications [20][21][22]. Lactate-level assessment has no benefit in prehospital setting [20][21][22].…”

Section: Early Shock Diagnosis In Prehospital Settingmentioning

confidence: 99%

“…Regarding biological parameters assessing tissue hypoxia, first high lactate level is associated to worsen prognosis, but lactate levels alone do not involve therapeutic management modifications [20][21][22]. Lactate-level assessment has no benefit in prehospital setting [20][21][22]. Some studies focused on the prehospital monitoring of arterial pressure.…”

Section: Early Shock Diagnosis In Prehospital Settingmentioning

confidence: 99%

Myocardial dysfunction after cardiac arrest: tips and pitfalls

Ortuno

Géri

Bouguoin

et al. 2022

European Journal of Emergency Medicine

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Postcardiac arrest shock (PCAS) is defined by hemodynamic instability occurring in the first hours after cardiac arrest (CA) and is a major cause of mortality among patients hospitalized after CA. It includes vasoplegia and myocardial dysfunction. This postcardiac arrest myocardial dysfunction is supposed to recover within the 3 days. However, there are many unknowns regarding its definition, its prognosis value and its management. In this review dedicated to emergency physicians, we choose to address tips and pitfalls they should know regarding this prevalent syndrome.

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Lactate and hypotension as predictors of mortality after in-hospital cardiac arrest

Cited by 31 publications

References 17 publications

Outcomes of arrest patients resuscitated in an emergency department: a prospective, observational study

Outcomes of arrest patients resuscitated in an emergency department: a prospective, observational study

Investigating Novel and Conventional Biomarkers for Post-resuscitation Prognosis: The Role of Cytokeratin-18, Neuron-specific Enolase, and Lactate

Myocardial dysfunction after cardiac arrest: tips and pitfalls

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