Department of Emergency Medicine, University Hospitals of Leuven, Leuven, Belgium; KULeuven - University, Department of Public Health and Primary Care, Leuven, Belgium.
Department of Emergency Medicine, University Hospitals of Leuven, Leuven, Belgium.
Am J Emerg Med. 2021 Aug;46:56-62. doi: 10.1016/j.ajem.2021.03.013. Epub 2021 Mar 9.
Prognostication of survival after out-of-hospital cardiac arrest (OHCA) remains challenging with current guidelines recommending the prognostication no earlier than 72 h after return of spontaneous circulation (ROSC). Prognostic factors that could be used earlier after ROSC, like lactate clearance, are still being studied.
This paper aims to investigate the prognostic strength of early lactate clearance for survival after OHCA.
This retrospective observational single-center study focuses on patients for whom ROSC was achieved after OHCA. Patients ≥18 years admitted between September 2012 and January 2019, for which arterial serum lactate measurements were available immediately at and 3 h after hospital admission (T0 and T3), were included.
192 patients were included. Lactate clearance at T3 (p < 0.001) was identified as an independent predictor for 24 h, 48 h and 72 h survival. Witnessed arrest, bystander CPR and initial shockable rhythm were independent significant predictors for long term survival after ROSC (1 month, 3 months and 1 year; p < 0.05), but not for 24 h survival. Age (above or below 65 years) was not significant for predicting survival. Upon combination of witnessed arrest, bystander CPR and initial shockable rhythm in a multivariate logistic regression model for long term survival, the initial rhythm was the dominant factor in the combined model, making witnessed arrest and bystander CPR redundant.
Lactate clearance at T3 after ROSC is associated with 24 h, 48 h and 72 h survival. Further research is needed to determine how to incorporate lactate clearance as part of a clinically useful tool to predict long term survival.
目前的指南建议在自主循环恢复（ROSC）后至少 72 小时才能进行预后预测，因此对院外心脏骤停（OHCA）后生存的预后仍然具有挑战性。一些预后因素，如乳酸清除率，可以更早地在 ROSC 后使用，但仍在研究中。
本研究旨在探讨早期乳酸清除率对 OHCA 后生存的预后价值。
这是一项回顾性观察性单中心研究，研究对象为 ROSC 后发生 OHCA 的患者。纳入 2012 年 9 月至 2019 年 1 月期间入院，ROSC 后即刻（T0）和入院 3 小时（T3）有动脉血乳酸测量值的年龄≥18 岁的患者。
共纳入 192 例患者。T3 时的乳酸清除率（p<0.001）是 24 小时、48 小时和 72 小时生存的独立预测因素。目击者见证、旁观者心肺复苏（CPR）和初始可电击节律是 ROSC 后长期生存（1 个月、3 个月和 1 年；p<0.05）的独立显著预测因素，但不是 24 小时生存的预测因素。年龄（大于或小于 65 岁）对预测生存没有意义。在预测长期生存的多变量逻辑回归模型中，将目击者见证、旁观者 CPR 和初始可电击节律结合起来，初始节律是联合模型中的主要因素，使目击者见证和旁观者 CPR 变得多余。
ROSC 后 T3 时的乳酸清除率与 24 小时、48 小时和 72 小时的生存相关。需要进一步研究如何将乳酸清除率纳入预测长期生存的临床有用工具的一部分。
