Scientific Reports (Jan 2021)

Association between serum lactate level during cardiopulmonary resuscitation and survival in adult out-of-hospital cardiac arrest: a multicenter cohort study

  • Norihiro Nishioka,
  • Daisuke Kobayashi,
  • Junichi Izawa,
  • Taro Irisawa,
  • Tomoki Yamada,
  • Kazuhisa Yoshiya,
  • Changhwi Park,
  • Tetsuro Nishimura,
  • Takuya Ishibe,
  • Yoshiki Yagi,
  • Takeyuki Kiguchi,
  • Masafumi Kishimoto,
  • Toshiya Inoue,
  • Yasuyuki Hayashi,
  • Taku Sogabe,
  • Takaya Morooka,
  • Haruko Sakamoto,
  • Keitaro Suzuki,
  • Fumiko Nakamura,
  • Tasuku Matsuyama,
  • Yohei Okada,
  • Satoshi Matsui,
  • Atsushi Hirayama,
  • Satoshi Yoshimura,
  • Shunsuke Kimata,
  • Takeshi Shimazu,
  • Tetsuhisa Kitamura,
  • Takashi Kawamura,
  • Taku Iwami,
  • the CRITICAL Study Group Investigators

DOI
https://doi.org/10.1038/s41598-020-80774-4
Journal volume & issue
Vol. 11, no. 1
pp. 1 – 9

Abstract

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Abstract We aimed to investigate the association between serum lactate levels during cardiopulmonary resuscitation (CPR) and survival in patients with out-of-hospital cardiac arrest (OHCA). From the database of a multicenter registry on OHCA patients, we included adult nontraumatic OHCA patients transported to the hospital with ongoing CPR. Based on the serum lactate levels during CPR, the patients were divided into four quartiles: Q1 (≤ 10.6 mEq/L), Q2 (10.6–14.1 mEq/L), Q3 (14.1–18.0 mEq/L), and Q4 (> 18.0 mEq/L). The primary outcome was 1-month survival. Among 5226 eligible patients, the Q1 group had the highest 1-month survival (5.6% [74/1311]), followed by Q2 (3.6% [47/1316]), Q3 (1.7% [22/1292]), and Q4 (1.0% [13/1307]) groups. In the multivariable logistic regression analysis, the adjusted odds ratio of Q4 compared with Q1 for 1-month survival was 0.24 (95% CI 0.13–0.46). 1-month survival decreased in a stepwise manner as the quartiles increased (p for trend < 0.001). In subgroup analysis, there was an interaction between initial rhythm and survival (p for interaction < 0.001); 1-month survival of patients with a non-shockable rhythm decreased when the lactate levels increased (p for trend < 0.001), but not in patients with a shockable rhythm (p for trend = 0.72). In conclusion, high serum lactate level during CPR was associated with poor 1-month survival in OHCA patients, especially in patients with non-shockable rhythm.