Emergency department point-of-care tests during cardiopulmonary resuscitation to predict cardiac arrest outcomes

Abstract

Introduction: This study evaluated the role of point-of-care tests (POCT) such as blood lactate, anion gap (AG), base deficit, pH, N-terminal pro B-type natriuretic peptide (NT-proBNP), and troponin as the predictors of cardiac arrest outcomes in the emergency department (ED). Methods: We conducted a prospective, observational study in the ED of a tertiary care hospital in India. All the adult patients who received cardiopulmonary resuscitation (CPR) in the ED were included in the study. Blood samples were collected within 10 min of initiation of CPR for assay of POCTs. Outcomes assessed were the return of spontaneous circulation (ROSC), 24-h survival, survival to hospital discharge (STHD), survival at 7 days, and favorable neurological outcome (FNO) at day 7 of admission. Results: One hundred and fifty-one patients were included in the study (median age: 50 years, 65% males). Out of 151 cases, ROSC, survival at 7 days, STHD, and FNO was observed in 86 patients, six patients, five patients, and two patients, respectively. “No-ROSC” could be significantly predicted by raised lactate (odds ratio [OR]: 1.14, 95% confidence interval: 1.07–1.22) and NT-proBNP (OR: 1.05, 1.01–1.09) values at the time of cardiac arrest. “24-h mortality” could be significantly predicted by the raised lactate (OR: 1.14, 1.01–1.28), low arterial pH (OR: 0.05, 0.01–0.52), raised AG (OR: 1.08, 1.01–1.15), and lower base deficit (<−15) (OR: 1.07, 1.01–1.14). None of the other POCTs was found to be a predictor of other cardiac arrest outcomes. Conclusion: Among various POCTs, raised lactate assayed within 10 min of cardiac arrest can predict poor outcomes like “no-ROSC” and 24-h mortality.

Keywords

• cardiac arrest
• cardiopulmonary resuscitation
• point of care tests