Abstract 43: Could Serum Lactate Level Predict Neurological Outcome in Patients Undergoing Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest?
Until November 2013 and the printing of TTM trial, TH was a standard of treatment in OHCA.
In Italy 55.000 events of CA occur every year. Early Prognostication in neurological outcome is still difficult and controversial. We decided to investigate the influence of lactacidemia at the time of start(T0) TH and after 24 hours(T24) on neurological outcome at 6 months.
After the ischemic injury, microcirculation is dysfunctional. Lactacidemia explains how the microcirculation is going to restore itself1,2.
Methods: We did a retrospective analysis of 88 patients admitted to several Italian ICUs. Patients underwent TH trough endovascular or surface cooling. We tested lactate in mmol/L at ICU admission and after 24 hours. Neurological outcome was measured using the Pittsburgh Cerebral Performance Category Scale (CPC) by phone-interview. We analysed the data using the ROC curve.
Results: The mean value of Lactate at T0 was 5,7 mmol/L and and at T24 was 3,6 mmol/L. 47 patients had a good neurological outcome (CPC score of 1-2). 41 patients had a bad neurological outcome (CPC score 3-5).
Discussion and Conclusion: At T0 the AUC is 0,69, P value is 0,001. At T24 the AUC is 0,56, P value is 0,288.
Lower serum lactate at T0 is weakly associated with CPC 1-2 at 6 months. On the contrary there is no correlation between lower serum lactate at T24 and good neurological outcome. This conclusion is in contrast with current evidence based in literature3.
Despite Lactacidemia being a sign of microcirculatory damage, our study explains that Lactate at T24 can not be used to predict the neurological outcome. More studies are needed to explain if Lactates Level could be a strong prognostication index.
1“Post-cardiac arrest syndrome” Nolan et al. Resuscitation 2008;79
2“Microcirculation during CA and resuscitation” Fries M, et al. Crit Care Med 2006;34
3“Association of serum lactate and survival outcomes in patients undergoing
TH after CA” Starodub et al; Resuscitation 2013;84
Author Disclosures: F. Verginella: None. A. Scamperle: None. P. Rossini: None. M. Zuliani: None. V. Campanile: None. A. Peratoner: None. F. Alongi: None.
- © 2014 by American Heart Association, Inc.