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Impact of rapid lactate clearance as an indicator of hemodynamic optimization on outcome in out-of-hospital cardiac arrest: A retrospective analysis.

ABSTRACT: OBJECTIVE:We analyzed the impact of rapid lactate clearance as an indicator of hemodynamic optimization on the outcome of out-of-hospital cardiac arrest (OHCA) during early post-cardiac arrest care (PCAC). METHODS:This retrospective analysis was based on a prospective cohort. We selected adult patients with OHCA who achieved a survival event between May 2006 and December 2017. Serum lactate levels were measured at 0 and 6 h after a survival event. The lactate clearance rate was calculated as (lactate at 0 h-lactate at 6 h)/lactate at 0 h. The threshold lactate clearance value for predicting survival to discharge was determined by receiver operating characteristic (ROC) curve analysis. Rapid lactate clearance was defined as the lactate clearance above the threshold value or normalization of serum lactate level (<2.0 mmol/L) at 6 h after a survival event. The primary outcome was survival to discharge. Multivariate logistic regression was used to predict survival to discharge. RESULTS:We enrolled 335 patients. 145 patients (43.3%) survived at discharge. The threshold value of lactate clearance was ?34% to predict survival to discharge. After adjustment for confounders, the adjusted odds ratios for no hypotension at both 0 and 6 hours and for the presence of rapid lactate clearance for survival to discharge were 8.018 (95% confidence interval [CI] 2.802-22.947) and 2.193 (95% CI 1.263-3.808), respectively. Among patients with early recovery from initial hypotension or with no hypotension events at both 0 and 6 hours, the survival rates were significantly higher in the rapid lactate clearance group than in the non-rapid lactate clearance group. CONCLUSIONS:During the early PCAC period, a rapid decrease in serum lactate level was an indicator of good outcome. Hemodynamic optimization including not only prevention and immediate correction of hypotension but also rapid lactate clearance should be considered in OHCA patients.

SUBMITTER: Han KS

PROVIDER: S-EPMC6443161 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Impact of rapid lactate clearance as an indicator of hemodynamic optimization on outcome in out-of-hospital cardiac arrest: A retrospective analysis.

Han Kap Su KS Kim Su Jin SJ Lee Eui Jung EJ Park Kyoung Yae KY Lee Ji Young JY Lee Sung Woo SW

PloS one 20190401 4

<h4>Objective</h4>We analyzed the impact of rapid lactate clearance as an indicator of hemodynamic optimization on the outcome of out-of-hospital cardiac arrest (OHCA) during early post-cardiac arrest care (PCAC).<h4>Methods</h4>This retrospective analysis was based on a prospective cohort. We selected adult patients with OHCA who achieved a survival event between May 2006 and December 2017. Serum lactate levels were measured at 0 and 6 h after a survival event. The lactate clearance rate was ca ...[more]

PMID: 30934011

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Project description:Background: Early prognostication is a major challenge after out-of-hospital cardiac arrest (OHCA). Aims: We hypothesized that a genome-wide analysis of blood gene expression could offer new prognostic tools and lines of research. Methods: Sixty-nine patients were enrolled from an ancillary study of the clinical trial NCT00999583 that tested the effect of erythropoietin (EPO) after OHCA. Blood samples were collected in comatose survivors of OHCA at hospital admission and 1 and 3 days after resuscitation. Gene expression profiles were analyzed (Illumina HumanHT-12 V4 BeadChip; >34,000 genes). Patients were classified into two categories representing neurologically favorable outcome (Cerebral Performance Category [CPC] = 1-2) vs unfavorable outcome (CPC>2) at Day 60 after OHCA. Differential and functional enrichment analyses were performed to compare transcriptomic profiles between these two categories. Results: Among the 69 enrolled patients, 33 and 36 patients were treated or not by EPO, respectively. Among them, 42% had a favorable neurological outcome in both groups. EPO did not affect the transcriptomic response at Day-0 and 1 after OHCA. In contrast, 76 transcripts differed at Day-0 between patients with unfavorable vs favorable neurological outcome. This signature persisted at Day-1 after OHCA. Functional enrichment analysis revealed a down-regulation of adaptive immunity with concomitant up-regulation of innate immunity and inflammation in patients with unfavorable vs favorable neurological outcome. The transcription of many genes of the HLA family was decreased in patients with unfavorable vs favorable neurological outcome. Concomitantly, neutrophil activation and inflammation were observed. Up-stream regulators analysis showed the implication of numerous factors involved in cell cycle and damages. A logistic regression including a set of genes allowed a reliable prediction of the clinical outcomes (Specificity=88%; Hit Rate=83%). Conclusions: A transcriptomic signature involving a counterbalance between adaptive and innate immune responses is able to predict neurological outcome very early after hospital admission after OHCA. This deserves confirmation in a larger population.

Project description:To analyze functional performance measures collected prospectively during the conduct of a clinical trial that enrolled children (up to age 18 yr old), resuscitated after out-of-hospital cardiac arrest, who were at high risk of poor outcomes.Children with Glasgow Motor Scale score less than 5, within 6 hours of resuscitation, were enrolled in a clinical trial that compared two targeted temperature management interventions (THAPCA-OH, NCT00878644). The primary outcome, 12-month survival with Vineland Adaptive Behavior Scale, second edition, score greater or equal to 70, did not differ between groups.Thirty-eight North American PICUs.Two hundred ninety-five children were enrolled; 270 of 295 had baseline Vineland Adaptive Behavior Scale, second edition, scores greater or equal to 70; 87 of 270 survived 1 year.Targeted temperatures were 33.0°C and 36.8°C for hypothermia and normothermia groups.Baseline measures included Vineland Adaptive Behavior Scale, second edition, Pediatric Cerebral Performance Category, and Pediatric Overall Performance Category. Pediatric Cerebral Performance Category and Pediatric Overall Performance Category were rescored at hospital discharges; all three were scored at 3 and 12 months. In survivors with baseline Vineland Adaptive Behavior Scale, second edition scores greater or equal to 70, we evaluated relationships of hospital discharge Pediatric Cerebral Performance Category with 3- and 12-month scores and between 3- and 12-month Vineland Adaptive Behavior Scale, second edition, scores. Hospital discharge Pediatric Cerebral Performance Category scores strongly predicted 3- and 12-month Pediatric Cerebral Performance Category (r = 0.82 and 0.79; p < 0.0001) and Vineland Adaptive Behavior Scale, second edition, scores (r = -0.81 and -0.77; p < 0.0001). Three-month Vineland Adaptive Behavior Scale, second edition, scores strongly predicted 12-month performance (r = 0.95; p < 0.0001). Hypothermia treatment did not alter these relationships.In comatose children, with Glasgow Motor Scale score less than 5 in the initial hours after out-of-hospital cardiac arrest resuscitation, function scores at hospital discharge and at 3 months predicted 12-month performance well in the majority of survivors.

Dataset Information

Impact of rapid lactate clearance as an indicator of hemodynamic optimization on outcome in out-of-hospital cardiac arrest: A retrospective analysis.

Publications

Impact of rapid lactate clearance as an indicator of hemodynamic optimization on outcome in out-of-hospital cardiac arrest: A retrospective analysis.

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