Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Resuscitation. 2021 Jan;158:208-214. doi: 10.1016/j.resuscitation.2020.10.018. Epub 2020 Oct 22.
Guidance on post-cardiac arrest prognostication is largely based on data from out-of-hospital cardiac arrest (OHCA), despite clear differences between the OHCA and in-hospital cardiac arrest (IHCA) populations. Early prediction of mortality after IHCA would be useful to help make decisions about post-arrest care. We evaluated the ability of lactate and need for vasopressors after IHCA to predict hospital mortality.
Single center retrospective observational study of adult IHCA patients who achieved sustained return of spontaneous circulation (ROSC), required mechanical ventilation peri-arrest and had a lactate checked within 2 h after ROSC. We evaluated the association of post-ROSC lactate and need for vasopressors with mortality using multivariate logistic regression.
A total of 364 patients were included. Patients who received vasopressors within 3 h after ROSC had significantly higher mortality compared to patients who did not receive vasopressors (58% vs. 43%, p = 0.03). Elevated lactate level was associated with mortality (44% if lactate <5 mmol/L, 58% if lactate 5-10 mmol/L, and 73% if lactate >10 mmol/L, p < 0.01). A multivariable model with lactate group and post-ROSC vasopressor use as predictors demonstrated moderate discrimination (AUC 0.64 [95%CI:0.59-0.70]). Including other variables, the most parsimonious model included lactate, age, body mass index, race, and history of arrhythmia, cancer and/or liver disease (AUC 0.70 [95% CI: 0.64-0.75]).
Post-ROSC lactate and need for vasopressors may be helpful in stratifying mortality risk in patients requiring mechanical ventilation after IHCA.
心脏骤停后预后的指导主要基于院外心脏骤停（OHCA）的数据，尽管 OHCA 和院内心脏骤停（IHCA）人群之间存在明显差异。早期预测 IHCA 后的死亡率将有助于做出关于心脏骤停后护理的决策。我们评估了 IHCA 后乳酸和升压药需求对预测医院死亡率的能力。
对成人 IHCA 患者进行单中心回顾性观察研究，这些患者达到持续自主循环恢复（ROSC），在心脏骤停期间需要机械通气，并在 ROSC 后 2 小时内检查乳酸。我们使用多变量逻辑回归评估了 ROSC 后乳酸和升压药需求与死亡率的相关性。
共纳入 364 例患者。在 ROSC 后 3 小时内接受升压药的患者死亡率明显高于未接受升压药的患者（58% vs. 43%，p=0.03）。乳酸水平升高与死亡率相关（如果乳酸<5mmol/L，则为 44%；如果乳酸为 5-10mmol/L，则为 58%；如果乳酸>10mmol/L，则为 73%，p<0.01）。以乳酸组和 ROSC 后升压药使用为预测因子的多变量模型显示出中等的区分度（AUC 0.64[95%CI：0.59-0.70]）。纳入其他变量后，最简约模型包括乳酸、年龄、体重指数、种族以及心律失常、癌症和/或肝病的病史，AUC 为 0.70[95%CI：0.64-0.75]。
在需要机械通气的 IHCA 后患者中，ROSC 后乳酸和升压药的需求可能有助于分层死亡率风险。
