Initial Blood Ammonia Level Is a Useful Prognostication Tool in Out-of-Hospital Cardiac Arrest　― Multicenter Prospective Study (SOS-KANTO 2012 Study) ―

Abstract

Initial blood ammonia level is as useful as other traditional prognostic indicators such as lactate. Measurement of both initial blood ammonia and lactate helped accurately predict neurological outcomes after OHCA.

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

“…Six articles reported lactate levels related to survival outcome; 4 articles did not provide sufficient data; 2 articles carried on CA patients under the age of 18; 2 articles included trauma cardiac arrest patients; 2 articles were letter to author; 1 was system review; and 1 was study abstract. Finally, 23 articles fulfilled our inclusion criteria [ 3 , 4 , 10 , 12 – 31 ].…”

“…22 articles [ 3 , 4 , 10 , 13 – 31 ] reported lactate levels at different time points related to neurological outcomes, which contained 6,553 participants. These studies were highly heterogeneous within I 2 > 90%.…”

“…In addition, we also pooled date of diagnostic test to evaluate the diagnostic efficiency of lactate level on admission. Nine studies reported the date of predict diagnostic test [ 12 , 15 , 17 , 22 , 23 , 25 , 27 , 29 , 31 ] and the information was shown in Table S2 . But only six studies reported sufficient data to calculate the number of true positive (TP), false positive (FP), false negative (FN), and true negative (TN) [ 12 , 15 , 17 , 23 , 29 , 31 ].…”

“…The primary end point was neurological outcomes at discharge from hospital or another follow-up time. Most of studies used Glasgow-Pittsburgh cerebral performance categories (CPC) to measure the neurological outcome after CA [ 3 , 10 , 12 – 18 , 20 – 31 ]. Good neurological outcome was defined as a CPC of 1-2 and poor neurological outcome was defined as a CPC of 3-5.…”

“…Effect size of lactate difference between different neurological outcomes patients was defined as weighed mean difference (WMD) and 95% confidence interval (CI). Articles reported data as interquartile range and median [ 4 , 10 , 13 – 17 , 19 , 21 , 23 – 25 , 27 , 30 , 31 ]. We converted data into mean and s.d.…”