Abstract 87: Lactate and Need for Vasopressors Predicts Mortality After Out-of-Hospital Cardiac Arrest
Background: Early prediction of outcome after out of hospital cardiac arrest (OHCA) is difficult. Previous work has indicated that the combination of lactate and the need for vasopressors may stratify patients and predict outcome.
Hypothesis: The combination of initial lactate and requirement for vasopressor support will predict survival post-arrest.
Methods: To validate previous retrospective findings, we conducted a prospective observational study of all OHCA (age >18, non-traumatic) patients presenting to the emergency department of a tertiary care center between June 2006 and July 2013 with ROSC. We conducted a logistic regression model with hypotensive status (yes or no) and lactate level (lactate <5, between 5-10 mmol/L and >10) as predictors of mortality.
Results: A total of 140 patients were enrolled. Median age of the cohort was 67 (IQR: 53-79.) 72% underwent mild therapeutic hypothermia. Overall mortality rate for the cohort was 60.71%. Patients who received vasopressors had a significantly higher mortality rate than those who did not receive vasopressors (69.4% v. 47.3% ; p=0.009). There was a step-wise increase in mortality associated with increasing lactate levels (37.0% lactate <5, 68.8% lactate 5-10, 95.5% lactate >10; p=0.0001). The AUC for our model was 0.76. Adjusting for hypotensive status, higher lactate levels were associated with increased odds of death compared to lactate 5-10 as the reference group (lactate 5-10 OR = 3.4, 95%CI: 1.6, 7.4; lactate >10 OR = 30.9, 95%CI: 3.8, 249.4). When adjusting for lactate level there was no significant increase in odds of death for patients who were hypotensive compared to patients who were not hypotensive (OR=0.541, 95%CI: 0.3, 1.2).
Conclusion: In this prospective validation of a previously retrospective finding, the combination of lactate and need for vasopressors in the immediate post-arrest period is predictive of mortality. Future multicenter validation of this tool is warranted.
- © 2013 by American Heart Association, Inc.