Predictive accuracy of biomarkers for survival among cardiac arrest patients with hypothermia: a prospective observational cohort study in Japan

Abstract

Background There is limited information on the predictive accuracy of commonly used predictors, such as lactate, pH or serum potassium for the survival among out-of-hospital cardiac arrest (OHCA) patients with hypothermia. This study aimed to identify the predictive accuracy of these biomarkers for survival among OHCA patients with hypothermia. Methods In this retrospective analysis, we analyzed the data from a multicenter, prospective nationwide registry among OHCA patients transported to emergency departments in Japan (the JAAM-OHCA Registry). We included all adult (≥18 years) OHCA patients with hypothermia (≤32.0 °C) who were registered from June 2014 to December 2017 and whose blood test results on hospital arrival were recorded. We calculated the predictive accuracy of pH, lactate, and potassium for 1-month survival. Results Of the 34,754 patients in the JAAM-OHCA database, we included 754 patients from 66 hospitals. The 1-month survival was 5.8% (44/754). The areas under the curve of the predictors and 95% confidence interval were as follows: pH 0.829 [0.767–0.877] and lactate 0.843 [0.793–0.882]. On setting the cutoff points of 6.9 in pH and 120 mg/dL (13.3 mmol/L) in lactate, the predictors had a high sensitivity (lactate: 0.91; pH 0.91) and a low negative likelihood ratio (lactate: 0.14; pH 0.13), which are suitable to exclude survival to 1 month. Furthermore, in additional analysis that included only the patients with potassium values available, a cutoff point of 7.0 (mmol/L) for serum potassium had high sensitivity (0.96) and a low negative likelihood ratio (0.09). Conclusion This study indicated the predictive accuracy of serum lactate, pH, and potassium for 1-month survival among adult OHCA patients with hypothermia. These biomarkers may help define a more appropriate resuscitation strategy.

External validation of 5A score model for predicting in-hospital mortality among the accidental hypothermia patients: JAAM-Hypothermia study 2018–2019 secondary analysis

“…In the process of considering treatment strategy, if physicians can provide the critical prognostic information to the patients or their family members, they will make the better clinical decisions considering their values, preference and goals of care [ 6 ]. Although some predictors or prediction models in patients with accidental hypothermia have been developed, the reproducibility or generalizability of their predictive performance has not been adequately evaluated [ 7 – 13 ]. Therefore, a valid and reliable prediction model that has been evaluated by an external validation study is needed for decision-making based on evidence-based predictions of prognosis.…”

2024 RECOVER Guidelines: Monitoring. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR

“…The results of the studies reporting the next most important outcomes of survival to discharge (4 observational studies; very low quality of evidence, downgraded for serious risk of bias and very serious indirectness) 110,114–116 and ROSC (5 observational studies; very low evidence, downgraded for serious risk of bias and very serious indirectness) 98,107,111,116,117 are similar to those reported for favorable neurologic outcome. In 1 report of 8 cats and 16 dogs in which blood samples were collected during ongoing CPR, blood potassium and sodium concentrations in animals with and without ROSC were not different 98 .…”

Intra‐arrest blood‐based biomarkers for out‐of‐hospital cardiac arrest: A scoping review

“…The search strategy identified a total of 11,834 records, of which 6914 were non‐duplicates. After applying all inclusion and exclusion criteria, 118 studies were included in the scoping review, as shown in Figure 1 11–128 …”