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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2011 November;77(11):1063-71
The association of lactate and vasopressor need for mortality prediction in survivors of cardiac arrest
Cocchi M. N. 1, 2, Miller J. 3, Hunziker S. 4, Carney E. 1, Salciccioli J. 1, Farris S. 5, Joyce N. 1, Zimetbaum P. 6, Howell M. D. 4, Donnino M. W. 1, 4 ✉
1 Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA;
2 Department of Anesthesia Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA;
3 Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA;
4 Division of Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston MA, USA;
5 Department of Emergency Medicine, Duke University, Durham, NC, USA;
6 Division of Cardiology, Department of MedicineBeth Israel Deaconess Medical Center, Boston, MA, USA
BACKGROUND;Currently there are few tools available for clinicians to predict outcomes in cardiac arrest survivors. Our objective was to determine if the combination of simple clinical parameters (initial blood lactate and vasopressor use) can predict outcome in post-cardiac arrest patients.
METHODS: The design was a retrospective medical record review. The study was carried on in two urban, tertiary-care, university teaching hospitals. As for patients, inclusion criteria were: 1) age ≥18 years; 2) non-traumatic out-of-hospital cardiac arrest with return of spontaneous circulation; 3) lactic acid measured within one hour of return of circulation. No interventions was performed.
RESULTS:Patients were divided into groups based on two variables: 1) vasopressor status (receipt of vasopressors vs. no vasopressors); and 2) initial blood lactate (categories defined as lactate <5 mmol/L, lactate 5 to 10 mmol/L, lactate ≥10 mmol/L); 128 out-of-hospital cardiac arrest patients met study inclusion criteria. Overall mortality was 71% (95%CI 63-79%). Patients who received vasopressors had significantly higher mortality rates compared to patients who did not receive vasopressors (80% vs. 52%; P=0.002). A stepwise increase in mortality is associated with increasing lactate levels (39% lactate <5 mmol/L, 67% lactate 5 mmol/L to10 mmol/L, and 92% lactate ≥10 mmol/L; P<0.001). The AUC for our model was 0.82.
CONCLUSION:The combination of two clinical parameters, vasopressor need and lactic acid levels, is an accurate severity of illness classification system and can predict mortality in patients following out-of-hospital cardiac arrest. Prospective validation of these variables in post-cardiac arrest is needed.