Abstract 231: Relationship Between Early Lactate Clearance With Improved Mortality in Cardiac Arrest Patients With Cardiopulmonary Bypass
Objective: Early lactate clearance has been reported to be associated with improved mortality in patients with post cardiac arrest syndrome. It seems that hypoperfusion plays in an important role in mortality. Recently, cardiopulmonary bypass (CPB) has significantly improved prognosis of those patients, however, it has been still unknown whether early lactate clearance associates with improved mortality in patients with CPB. The aim of this study was to investigate serial lactate change and short-term mortality in post cardiac arrest patients with CPB.
Methods: Retrospective observational study. Between January 2000 and May 2010, 42 cardiac arrest patients with cardiac causes underwent CPB in a university hospital in Tokyo. Of those, serial arterial lactate concentrations (at ICU admission and 6 hours after ICU admission) were obtained from 18 patients (17 Males, median 60 y/o). Lactate clearance was defined as the percent change after 6 hours from baseline. The patients were divided into two groups (high lactate clearance group or low lactate clearance) by median lactate clearance.
Results: The lactate clearance in the high lactate clearance group was 51.6±17.2% (mean±SD) and the low lactate clearance group −21.1±20.9%. There were no significant differences between the groups for demographics, laboratories (except platelets, base excess), baseline lactate (the high lactate clearance group: 9.9±3.9mmol/l, the low lactate clearance group:11.4±4.4mmol/l), baseline arterial pressure (102.8±36.2mmHg, 90.0±29.9mmHg), use of catecholamine. In the high clearance group, fluids during 6hrs (1.8±1.6L, 3.9±1.2L, p=0.01) was lower and blood pressure at 6hours (126.0±13.0, 83.3±22.5, p=0.04) was higher significantly. There were significantly higher for favorable CPC (<=2) rate (44% vs 0%, OR 2.8, 95%CI:1.3–5.6) and survival rate (66% vs 0%, 4.0:1.5–10.6) in the high clearance group. Kaplan-Meier survival analysis showed a survival benefit over 28 days (log-rank;p<0.001).
Conclusions: Early lactate clearance is associated with improved outcome in post cardiac arrest patients with CPB. These findings suggest that post arrest tissue hypoperfusion during CPB contributes lactate clearance, regardless CPB.
- © 2010 by American Heart Association, Inc.