1Division of Pediatric Critical Care, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 2Department of Pediatrics, University of Utah, Salt Lake City, UT. 3Department of Pediatrics, Children's National Medical Center, Washington, DC. 4Department of Pediatrics, Children's Hospital of New York, Columbia University, New York, NY. 5Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI.
Pediatr Crit Care Med. 2013 Oct;14(8):e380-7. doi: 10.1097/PCC.0b013e3182976402.
To describe the association of lactate levels within the first 12 hours after successful resuscitation from pediatric cardiopulmonary arrest with hospital mortality.
Retrospective cohort study.
Fifteen children's hospital associated with the Pediatric Emergency Care Applied Research Network.
Patients between 1 day and 18 years old who had a cardiopulmonary arrest, received chest compressions more than 1 minute, had a return of spontaneous circulation more than 20 minutes, and had lactate measurements within 6 hours of arrest.
None.
Two hundred sixty-four patients had a lactate sampled between 0 and 6 hours (lactate(0-6)) and were evaluable. Of those, 153 patients had a lactate sampled between 7 and 12 hours (lactate(7-12)). One hundred thirty-eight patients (52%) died. After controlling for arrest location, total number of epinephrine doses, initial rhythm, and other potential confounders, the odds of death per 1 mmol/L increase in lactate(0-6) was 1.14 (1.08, 1.19) (p < 0.001) and the odds of death per 1 mmol/L increase in lactate(7-12) was 1.20 (1.11, 1.30) (p < 0.0001). Area under the curve for in-hospital arrest mortality for lactate(0-6) was 0.72 and for lactate(7-12) was 0.76. Area under the curve for out-of-hospital arrest mortality for lactate(0-6) was 0.8 and for lactate(7-12) was 0.75.
Elevated lactate levels in the first 12 hours after successful resuscitation from pediatric cardiac arrest are associated with increased mortality. Lactate levels alone are not able to predict outcomes accurately enough for definitive prognostication but may approximate mortality observed in this large cohort of children's hospitals.
描述心肺复苏后 12 小时内乳酸水平与医院死亡率的关系。
回顾性队列研究。
与儿科急诊护理应用研究网络相关的 15 家儿童医院。
心肺复苏后 1 天至 18 岁，接受胸外按压超过 1 分钟，自主循环恢复超过 20 分钟，且在心脏骤停后 6 小时内测量乳酸。
无。
264 例患者在 0 至 6 小时（乳酸（0-6））之间采集了一份乳酸样本，且可评估。其中，153 例患者在 7 至 12 小时（乳酸（7-12））之间采集了一份乳酸样本。138 例患者（52%）死亡。在控制了复苏地点、肾上腺素剂量总数、初始节律和其他潜在混杂因素后，每增加 1mmol/L 乳酸（0-6）的死亡几率为 1.14（1.08，1.19）（p<0.001），每增加 1mmol/L 乳酸（7-12）的死亡几率为 1.20（1.11，1.30）（p<0.0001）。乳酸（0-6）的院内心跳骤停死亡率的曲线下面积为 0.72，乳酸（7-12）的曲线下面积为 0.76。乳酸（0-6）的院外心跳骤停死亡率的曲线下面积为 0.8，乳酸（7-12）的曲线下面积为 0.75。
心肺复苏后 12 小时内乳酸水平升高与死亡率增加有关。单独的乳酸水平不足以准确预测预后，但可能接近本大儿童医院队列的观察死亡率。
