Abstract
We aimed to investigate the association between serum lactate levels during cardiopulmonary resuscitation (CPR) and survival in patients with out-of-hospital cardiac arrest (OHCA). From the database of a multicenter registry on OHCA patients, we included adult nontraumatic OHCA patients transported to the hospital with ongoing CPR. Based on the serum lactate levels during CPR, the patients were divided into four quartiles: Q1 (≤ 10.6 mEq/L), Q2 (10.6–14.1 mEq/L), Q3 (14.1–18.0 mEq/L), and Q4 (> 18.0 mEq/L). The primary outcome was 1-month survival. Among 5226 eligible patients, the Q1 group had the highest 1-month survival (5.6% [74/1311]), followed by Q2 (3.6% [47/1316]), Q3 (1.7% [22/1292]), and Q4 (1.0% [13/1307]) groups. In the multivariable logistic regression analysis, the adjusted odds ratio of Q4 compared with Q1 for 1-month survival was 0.24 (95% CI 0.13–0.46). 1-month survival decreased in a stepwise manner as the quartiles increased (p for trend < 0.001). In subgroup analysis, there was an interaction between initial rhythm and survival (p for interaction < 0.001); 1-month survival of patients with a non-shockable rhythm decreased when the lactate levels increased (p for trend < 0.001), but not in patients with a shockable rhythm (p for trend = 0.72). In conclusion, high serum lactate level during CPR was associated with poor 1-month survival in OHCA patients, especially in patients with non-shockable rhythm.
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1 Kyoto University School of Public Health, Department of Preventive Services, Kyoto, Japan (GRID:grid.258799.8) (ISNI:0000 0004 0372 2033)
2 Kyoto University Health Service, Kyoto, Japan (GRID:grid.258799.8) (ISNI:0000 0004 0372 2033)
3 Kyoto University School of Public Health, Department of Preventive Services, Kyoto, Japan (GRID:grid.258799.8) (ISNI:0000 0004 0372 2033); Okinawa Prefectural Yaeyama Hospital, Department of Medicine, Ishigaki, Japan (GRID:grid.474866.f)
4 Osaka University Graduate School of Medicine, Department of Traumatology and Acute Critical Medicine, Suita, Japan (GRID:grid.136593.b) (ISNI:0000 0004 0373 3971)
5 Osaka Police Hospital, Emergency and Critical Care Medical Center, Osaka, Japan (GRID:grid.416980.2) (ISNI:0000 0004 1774 8373)
6 Kansai Medical University, Takii Hospital, Department of Emergency and Critical Care Medicine, Moriguchi, Japan (GRID:grid.410783.9) (ISNI:0000 0001 2172 5041)
7 Tane General Hospital, Department of Emergency Medicine, Osaka, Japan (GRID:grid.416901.b) (ISNI:0000 0004 0596 0158)
8 Osaka City University, Department of Critical Care Medicine, Osaka, Japan (GRID:grid.261445.0) (ISNI:0000 0001 1009 6411)
9 Kindai University Faculty of Medicine, Department of Emergency and Critical Care Medicine, Osaka-Sayama, Japan (GRID:grid.258622.9) (ISNI:0000 0004 1936 9967)
10 Osaka Mishima Emergency Critical Care Center, Takatsuki, Japan (GRID:grid.452656.6) (ISNI:0000 0004 0623 203X)
11 Osaka General Medical Center, Critical Care and Trauma Center, Osaka, Japan (GRID:grid.452656.6)
12 Osaka Prefectural Nakakawachi Medical Center of Acute Medicine, Higashi-Osaka, Japan (GRID:grid.452656.6)
13 Senshu Trauma and Critical Care Center, Osaka, Japan (GRID:grid.452656.6)
14 Saiseikai Senri Hospital, Senri Critical Care Medical Center, Suita, Japan (GRID:grid.452656.6)
15 National Hospital Organization Osaka National Hospital, Traumatology and Critical Care Medical Center, Osaka, Japan (GRID:grid.416803.8) (ISNI:0000 0004 0377 7966)
16 Osaka City General Hospital, Emergency and Critical Care Medical Center, Osaka, Japan (GRID:grid.416948.6) (ISNI:0000 0004 1764 9308)
17 Osaka Red Cross Hospital, Department of Pediatrics, Osaka, Japan (GRID:grid.417000.2) (ISNI:0000 0004 1764 7409)
18 Kishiwada Tokushukai Hospital, Emergency and Critical Care Medical Center, Osaka, Japan (GRID:grid.415384.f) (ISNI:0000 0004 0377 9910)
19 Kansai Medical University, Department of Emergency and Critical Care Medicine, Hirakata, Osaka, Japan (GRID:grid.410783.9) (ISNI:0000 0001 2172 5041)
20 Kyoto Prefectural University of Medicine, Department of Emergency Medicine, Kyoto, Japan (GRID:grid.272458.e) (ISNI:0000 0001 0667 4960)
21 Osaka University, Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka, Japan (GRID:grid.136593.b) (ISNI:0000 0004 0373 3971)
22 Osaka University Graduate School of Medicine, Public Health, Department of Social and Environmental Medicine, Osaka, Japan (GRID:grid.136593.b) (ISNI:0000 0004 0373 3971)