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Early lactate elevations following resuscitation from pediatric cardiac arrest are associated with increased
Alexis A Topjian1, Amy E Clark, T Charles Casper
11Division of Pediatric Critical Care, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 2Department of Pediatrics, University of Utah, Salt Lake City, UT. 3Department of Pediatrics, Children's National Medical Center, Washington, DC. 4Department of Pediatrics, Children's Hospital of New York, Columbia University, New York, NY. 5Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI.
Insights
Elevated lactate levels within 12 hours of pediatric cardiac arrest indicate higher mortality risk. While not definitive for prognostication, lactate measurements offer valuable insights into survival outcomes in children.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiovascular Research
- Biochemistry and Metabolism
Background:
- Pediatric cardiopulmonary arrest (CPA) carries a high mortality rate.
- Lactate levels are a known marker of tissue hypoperfusion and metabolic distress.
- Understanding the prognostic value of early lactate levels post-resuscitation is crucial for clinical decision-making.
Purpose of the Study:
- To investigate the association between lactate levels within the first 12 hours following successful resuscitation from pediatric CPA and in-hospital mortality.
- To evaluate the predictive capability of early lactate measurements for patient outcomes.
Main Methods:
- A retrospective cohort study was conducted across 15 children's hospitals within the Pediatric Emergency Care Applied Research Network.
- Included patients were aged 1 day to 18 years, experiencing CPA with return of spontaneous circulation.
- Lactate levels were measured within 6 and 7-12 hours post-resuscitation.
Main Results:
- A total of 264 patients had lactate measurements within 0-6 hours (lactate(0-6)) and 153 within 7-12 hours (lactate(7-12)).
- Overall in-hospital mortality was 52% (138 patients).
- Increased lactate levels (both lactate(0-6) and lactate(7-12)) were significantly associated with higher odds of death, even after adjusting for confounders. Area under the curve values ranged from 0.72 to 0.8.
Conclusions:
- Elevated lactate levels in the initial 12 hours post-pediatric CPA resuscitation are significantly associated with increased hospital mortality.
- Lactate levels alone may not be sufficient for definitive prognostication but provide valuable predictive information.
- These findings support the use of serial lactate measurements in managing pediatric CPA survivors.
Objective:
To describe the association of lactate levels within the first 12 hours after successful resuscitation from pediatric cardiopulmonary arrest with hospital mortality.
Design:
Retrospective cohort study.
Setting:
Fifteen children's hospital associated with the Pediatric Emergency Care Applied Research Network.
Patients:
Patients between 1 day and 18 years old who had a cardiopulmonary arrest, received chest compressions more than 1 minute, had a return of spontaneous circulation more than 20 minutes, and had lactate measurements within 6 hours of arrest.
Interventions:
None.
Measurements And Main Results:
Two hundred sixty-four patients had a lactate sampled between 0 and 6 hours (lactate(0-6)) and were evaluable. Of those, 153 patients had a lactate sampled between 7 and 12 hours (lactate(7-12)). One hundred thirty-eight patients (52%) died. After controlling for arrest location, total number of epinephrine doses, initial rhythm, and other potential confounders, the odds of death per 1 mmol/L increase in lactate(0-6) was 1.14 (1.08, 1.19) (p < 0.001) and the odds of death per 1 mmol/L increase in lactate(7-12) was 1.20 (1.11, 1.30) (p < 0.0001). Area under the curve for in-hospital arrest mortality for lactate(0-6) was 0.72 and for lactate(7-12) was 0.76. Area under the curve for out-of-hospital arrest mortality for lactate(0-6) was 0.8 and for lactate(7-12) was 0.75.
Conclusions:
Elevated lactate levels in the first 12 hours after successful resuscitation from pediatric cardiac arrest are associated with increased mortality. Lactate levels alone are not able to predict outcomes accurately enough for definitive prognostication but may approximate mortality observed in this large cohort of children's hospitals.
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