Initial Lactate and Lactate Change in Post–Cardiac Arrest

Abstract

Introduction Rate of lactate change is associated with in-hospital mortality in post-cardiac arrest patients. This association has not been validated in a prospective multicenter study. Objective To determine the association between percent lactate change and outcomes in post-cardiac arrest patients. Methods Four-center prospective observational study conducted from June 2011 to March 2012. Inclusion criteria consisted of adult out-of-hospital non-traumatic cardiac arrest patients who were comatose after return of spontaneous circulation. The primary outcome was survival to hospital discharge, and secondary outcome was good neurological outcome. We compared the absolute lactate levels and the differences in the percent lactate change over 24-hrs between survivors and non-survivors and between subjects with good and bad neurological outcomes. Results 100 patients were analyzed. The median age was 63 years (IQR: 50 – 75) and 40% were female. 97% received therapeutic hypothermia and overall survival was 46%. Survivors and patients with good neurological outcome had lower lactate levels at 0, 12 and 24 hours (p < 0.01). In adjusted models percent lactate decrease at 12 hours was greater in survivors (OR 2.2 [95% CI 1.1 – 6.2]) and in those with good neurological outcome (OR 2.2 [95% CI 1.1 – 4.4]). Conclusion Lower lactate levels at 0, 12 and 24 hours as well as greater percent decrease in lactate over the first 12-hours post-cardiac arrest are associated with survival and good neurologic outcome.

Prognosis of patients presenting extreme acidosis (pH <7) on admission to intensive care unit

“…Our results are in agreement with Donnino et al, a prospective study of lactate levels following cardiac arrest, which recorded a mortality rate of 80% in patients where initial lactate was greater than 10 mmol.l -1 [8].…”

“…The existing literature on acidosis in intensive care unit (ICU) mainly consists of analyses of specific causes of metabolic acidosis, with little on management of severe cases; there is no study comparing different causes [6][7][8][9]. As regards to shock with severe lactic acidosis with pH <7.2, observed mortality rate is about 50%, while several study have reported universal mortality in case of shock with lactic acidosis under pH 7.0 [10][11][12][13].…”

APACHE II Score Immediately after Cardiac Arrest as a Predictor of Good Neurological Outcome in Out-of-Hospital Cardiac Arrest Patients Receiving Targeted Temperature Management

“…Thus, monitoring of lactate in this setting may be of more value to assess the severity of tissue hypoxia than just blood pressure or cardiac output. Other studies have also shown the prognostic value of admission blood lactate levels after CA and of changes in lactate levels in the hours after CA [22][23][24][25].…”

“…Moreover, Roberts et al [8] did not record blood lactate levels and we observed that increased lactate concentrations after CA were significantly associated with ICU mortality. As high lactate concentrations are primarily a consequence of prolonged CA and/or severe subsequent hemodynamic impairment [22][23][24], lactate can be considered as an extracerebral variable that is predictive of poor outcome in these patients. Abnormalities in tissue perfusion occurring after CA may also potentially contribute to brain hypoperfusion and development of MOF [7].…”

Miokardo pažeidimas kardiochirurginių operacijų metu ir galimi apsaugos būdai

“…Pieno rūgšties koncentracija kraujo serume atspindi anaerobinio metabolizmo proceso dydį. Tyrimais nustatyta, kad kuo didesnė pieno rūgšties koncentracija kraujo serume ir metabolinės acidozės gylis, tuo blogesnė baigtis ir didesnė mirštamumo rizika [28,29]. Miokardo pažeidimas, kuomet po išemijos einanti reperfuzija pažeidžia širdies ląsteles, buvo pastebėtas Jennings ir kol.…”