Initial blood pH during cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients: a multicenter observational registry-based study

Abstract

BackgroundWhen an out-of-hospital cardiac arrest (OHCA) patient receives cardiopulmonary resuscitation (CPR) in the emergency department (ED), blood laboratory test results can be obtained by using point-of-care testing during CPR. In the present study, the relationship between blood laboratory test results during CPR and outcomes of OHCA patients was investigated.MethodsThis study was a multicenter retrospective analysis of prospective registered data that included 2716 OHCA patients. Data from the EDs of three university hospitals in different areas were collected from January 2009 to December 2014. Univariate and multivariable analyses were conducted to elucidate the factors associated with survival to discharge and neurological outcomes. A final analysis was conducted by including patients who had no prehospital return of spontaneous circulation and those who underwent rapid blood laboratory examination during CPR.ResultsOverall, 2229 OHCA patients were included in the final analysis. Among them, the rate of survival to discharge and a good Cerebral Performance Categories Scale score were 14% and 4.4%, respectively. The pH level was independently related to survival to hospital discharge (adjusted OR 6.287, 95% CI 2.601–15.197; p < 0.001) and good neurological recovery (adjusted OR 15.395, 95% CI 3.439–68.911; p < 0.001). None of the neurologically intact patients had low pH levels (< 6.8) or excessive potassium levels (> 8.5 mEq/L) during CPR.ConclusionsAmong the blood laboratory test results during CPR of OHCA patients, pH and potassium levels were observed as independent factors associated with survival to hospital discharge, and pH level was considered as an independent factor related to neurological recovery.

Cardiopulmonary resuscitation in poorly resourced settings: better to pre-empt than to wait until it is too late

“…Predictors of outcome are age (younger children do better), pre-arrest morbidity, where the arrest occurred, cardiac rhythm and duration of CPR [20]. Reported predictors of poor neurological outcome include duration of CPR >10 min (p = 0.013); out-of-hospital CA (p = 0.005); arterial pH <6.8 (p = 0.014); arterial lactate >2 mmol/L (p = 0.004); lack of pupil activity, absent brain stem reflexes and, on EEG, background suppression (all p < 0.001) [21,22]. In ICUs, if there has been a CA preadmission, a re-arrest is six times more likely than an in-ICU arrest, and, if the arrest occurred within 4 h of admission, there is a 50% chance of re-arrest, both circumstances leading to a poor long-term outcome [23].…”

Prognostic value of venous blood analysis at the start of CPR in non-traumatic out-of-hospital cardiac arrest: association with ROSC and the neurological outcome

“…Along with the cardiac arrest onset and first monitored rhythm, it seems that the metabolic status during CPR would be another important factor with a relevant impact on the probability of survival and on the neurological outcome [4].…”

Association between pH and neurological outcome among cardiac arrest patients treated by extracorporeal CPR: a prospective observational cohort study in Japan

“…One other observational study indicated that the pH value during resuscitation was related to neurological outcome; however, this study did not include patients with ECPR. 6 Currently, little is known about the association between pH value before the implementation of ECPR and neurological outcome among OHCA patients treated by ECPR. Our study aimed to determine the association between the pH value before implementation of ECPR and neurological outcome, among OHCA patients treated with ECPR.…”