Thromboelastometric analysis of the risk factors for return of spontaneous circulation in adult patients with out-of-hospital cardiac arrest

Abstract

It is well known that coagulopathy is observed in patients with out-of-hospital cardiac arrest (OHCA). Thrombolytic therapy for those patients has been controversial until now. The purpose of this study was to identify a significant predictor for return of spontaneous circulation (ROSC) of OHCA patients in the emergency department (ED) using whole blood viscoelastic testing. Adult non-trauma OHCA patients transported to our hospital that underwent thromboelastometry (ROTEM) during cardiopulmonary resuscitation between January 2013 and December 2015 were enrolled in this study. We divided patients into two groups based on the presence or absence of ROSC, and performed statistical analysis utilizing patient characteristics, prehospital data, laboratory data, and ROTEM data. Seventy-five patients were enrolled. The ROSC group and non-ROSC group included 23 and 52 patients, respectively. The logistic regression analysis, utilizing significant parameters by univariate analysis, demonstrated that lactate level [odds ratio (OR) 0.880, 95% confidence interval (CI) 0.785–0.986, p = 0.028] and A30 of EXTEM test [OR 1.039, 95% CI 1.010–1.070, p = 0.009] were independent risk factors for ROSC. The cut-off values of lactate and A30 in EXTEM were 12.0 mmol/L and A 48.0 mm, respectively. We defined a positive prediction for ROSC if the patient presented lower lactate level (<12.0 mmol/L) and higher A30 of EXTEM (≥48.0 mm) with high specificity (94.7%) and accuracy (75.0%). The present study showed that lactate level and ROTEM parameter of clot firmness were reliable predictors of ROSC in the ED for adult patients with OHCA.

Blood Lactate or Lactate Clearance: Which Is Robust to Predict the Neurological Outcomes after Cardiac Arrest? A Systematic Review and Meta-Analysis

“…Therefore lactate was measured routinely in cardiac arrest patients or even other critically ill patients to assess short or long-term prognosis [ 39 ]. In cardiac arrest patients, patients with a lower lactate level on admission have higher possibility of ROSC [ 40 ]. One recent meta-analysis by Debaty et al [ 41 ] also revealed that patients with a lower serum lactate level on hospital admission were associated with better survival outcomes.…”

Relationship Between Severity of Fibrinolysis Based on Rotational Thromboelastometry and Conventional Fibrinolysis Markers

“…18 However, these studies did not evaluate the association of ROTEM parameters with conventional fibrinolytic variables. [17][18][19][20][21] A detailed association between conventional coagulofibrinolytic variables and ROTEM parameters remains unclear. Therefore, we conducted this study to evaluate the relationship between the severity of fibrinolysis based on ROTEM and conventional fibrinolysis markers, especially t-PA, plasminogen (PLG), a 2 -plasmin inhibitor (a2-PI), and total plasminogen activator inhibitor (PAI), in patients with OHCA.…”

“… 17 - 21 Hyperfibrinolysis was defined by maximum lysis, which indicated a percentage decrease in clot firmness from maximum clot firmness during the observation time and lysis onset time (LOT), which indicated time (in seconds) from the start of clotting (clotting time) to the initiation of clot lysis. 17 - 21 Furthermore, hyperfibrinolysis was associated with base excess, 17 lactate levels, 17 , 18 and cardiopulmonary resuscitation time. 18 However, these studies did not evaluate the association of ROTEM parameters with conventional fibrinolytic variables.…”

“… 18 However, these studies did not evaluate the association of ROTEM parameters with conventional fibrinolytic variables. 17 - 21 …”

“…Viscoelastic devices, such as ROTEM, are widely used in various clinical situations, such as liver transplantation, 8,9 trauma, [10][11][12] postpartum hemorrhage, 13,14 and cardiac surgery 15,16 as well as in patients who have sustained a cardiac arrest. [17][18][19][20] In previous studies, hyperfibrinolysis in patients with OHCA was frequently diagnosed by ROTEM. [17][18][19][20][21] Hyperfibrinolysis was defined by maximum lysis, which indicated a percentage decrease in clot firmness from maximum clot firmness during the observation time and lysis onset time (LOT), which indicated time (in seconds) from the start of clotting (clotting time) to the initiation of clot lysis.…”