The prognostic value of early lactate clearance for survival after out-of-hospital cardiac arrest.

Abstract

BACKGROUND\nPrognostication of survival after out-of-hospital cardiac arrest (OHCA) remains challenging with current guidelines recommending the prognostication no earlier than 72\xa0h after return of spontaneous circulation (ROSC). Prognostic factors that could be used earlier after ROSC, like lactate clearance, are still being studied.\n\n\nOBJECTIVES\nThis paper aims to investigate the prognostic strength of early lactate clearance for survival after OHCA.\n\n\nMETHODS\nThis retrospective observational single-center study focuses on patients for whom ROSC was achieved after OHCA. Patients ≥18\xa0years admitted between September 2012 and January 2019, for which arterial serum lactate measurements were available immediately at and 3\xa0h after hospital admission (T0 and T3), were included.\n\n\nRESULTS\n192 patients were included. Lactate clearance at T3 (p\xa0<\xa00.001) was identified as an independent predictor for 24\xa0h, 48\xa0h and 72\xa0h survival. Witnessed arrest, bystander CPR and initial shockable rhythm were independent significant predictors for long term survival after ROSC (1\xa0month, 3\xa0months and 1\xa0year; p\xa0<\xa00.05), but not for 24\xa0h survival. Age (above or below 65\xa0years) was not significant for predicting survival. Upon combination of witnessed arrest, bystander CPR and initial shockable rhythm in a multivariate logistic regression model for long term survival, the initial rhythm was the dominant factor in the combined model, making witnessed arrest and bystander CPR redundant.\n\n\nCONCLUSION\nLactate clearance at T3 after ROSC is associated with 24\xa0h, 48\xa0h and 72\xa0h survival. Further research is needed to determine how to incorporate lactate clearance as part of a clinically useful tool to predict long term survival.