학술논문
Impact of Lactate Clearance on Clinical and Neurological Outcomes of Patients With Out-of-Hospital Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation: A Secondary Data Analysis*
Document Type
Academic Journal
Author
Sugimoto, Momoko; Takayama, Wataru; Inoue, Akihiko; Hifumi, Toru; Sakamoto, Tetsuya; Kuroda, Yasuhiro; Otomo, Yasuhiro; Senda, Asae; Suzuki, Hajime; Tanimoto, Atsunori; Kitagawa, Kanta; Katayama, Yoichi; Igarashi, Nobuaki; Kawano, Masayuki; Kuroki, Yuji; Umehara, Tadashi; Sasaki, Yukari; Tominaga, Naoki; Hamaguchi, Takuro; Sakai, Takuma; Abe, Takeru; Hanafusa, Hiroaki; Yamaoka, Yuki; Kakizaki, Yumi; Sakato, Shinya; Kashiwabara, Shiho; Kadoya, Takashi; Misumi, Kayo; Kobayashi, Takaomi; Yamada, Sou; Kobayashi, Masakazu; Akashi, Naoko; Kuno, Masamune; Maruyama, Jun; Kobata, Hitoshi; Soh, Mitsuhito; Shirasaki, Kasumi; Shiba, Daiki; Isokawa, Shutaro; Uchida, Masatoshi; Sakurai, Atsushi; Tatsukawa, Hirotaka; Nishikawa, Marie; Kojima, Mitsuaki; Kosaki, Ryohei; Shimazui, Takashi; Kinoshita, Hiroki; Sawada, Yusuke; Yamamoto, Ryo; Masuzawa, Yuya; Matsumura, Kazuki; Shimazaki, Junya
Source
Critical Care Medicine. Jul 01, 2024 52(7):e341-e350
Subject
Language
English
ISSN
0090-3493
Abstract
OBJECTIVES:: Serial evaluations of lactate concentration may be more useful in predicting outcomes in patients with out-of-hospital cardiac arrest (OHCA) than a single measurement. This study aimed to evaluate the impact of lactate clearance (LC) on clinical and neurologic outcomes in patients with OHCA who underwent extracorporeal cardiopulmonary resuscitation (ECPR). DESIGN:: Retrospective multicenter observational study. SETTING:: Patients with OHCA receiving ECPR at 36 hospitals in Japan between January 1, 2013, and December 31, 2018. PATIENTS:: This study evaluated 1227 patients, with lactateinitial assessed upon emergency department admission and lactatesecond measured subsequently. To adjust for the disparity in the time between lactate measurements, the modified 6-hour LC was defined as follows: ([lactateinitial–lactatesecond]/lactateinitial) × 100 × (6/the duration between the initial and second measurements [hr]). The patients were divided into four groups according to the modified 6-hour LC with an equivalent number of patients among LC quartiles: Q1 (LC < 18.8), Q2 (18.8 < LC < 59.9), Q3 (60.0 < LC < 101.2), and Q4 (101.2 < LC). INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: The 30-day survival rates increased as the 6-hour LC increased (Q1, 21.2%; Q2, 36.8%; Q3, 41.4%; Q4, 53.6%; p for trend < 0.001). In the multivariate analysis, the modified 6-hour LC was significantly associated with a 30-day survival rate (adjusted odds ratio [AOR], 1.003; 95% CI, 1.001–1.005; p < 0.001) and favorable neurologic outcome (AOR, 1.002; 95% CI, 1.000–1.004; p = 0.027). CONCLUSIONS:: In patients with OHCA who underwent ECPR, an increase in the modified 6-hour LC was associated with favorable clinical and neurologic outcome. Thus, LC can be a criterion to assess whether ECPR should be continued.