Abstract 38: Lactate Clearance Is Associated with Improved Survival and Neurological Outcome in Post--Cardiac Arrest
Introduction: Previous investigations demonstrated an association between lactate clearance and in-hospital mortality in post-cardiac arrest patients. These findings have yet to be validated in a multicenter study.
Objective: To determine the association between lactate clearance and outcomes in post-cardiac arrest
Methods: Four center prospective observational study conducted from 6/11 to 3/12. Inclusion criteria consisted of adult out-of-hospital non-traumatic cardiac arrest patients who were comatose after ROSC. The primary outcome was difference in lactate clearance between survivors/non-survivors, and secondary outcome was the difference in lactate clearance between those with good/poor neurological outcome. We compared baseline lactate between survivors and non-survivors using the students t-test. We used multivariate adjustments (age and downtime) with linear mixed-models to assess the trend in lactate clearance over 24-hrs between survivors/non-survivors and good/bad neurological outcome.
Results: 111 patients were analyzed. The median age was 63 years (IQR: 50 - 75) and 41% were female. 97% received TH and overall survival was 47%. Survivors had lower baseline lactate levels compared to non-survivors (5.1 +/- 3.4 versus 7.7 +/- 4.7; p = 0.004). Patients with good neurologic outcomes had lower baseline levels of lactic acid compare to patients with poor neurologic outcomes (4.6 +/- 2.6 versus 7.4 +/- 4.7; p = 0.009). After multivariate adjustments survivors had better lactate clearance than non-survivors (p < 0.001; Figure) and patients with good neurologic status had better lactate clearance compared those with poor neurologic status (p = 0.01).
Conclusion: Lower initial lactate as well as more efficient lactate clearance over the first 24-hours post-CA is associated with improved in-hospital survival and good neurologic outcome.
- © 2012 by American Heart Association, Inc.