Evaluating traditional prognostic measures in patients undergoing hypothermia after cardiac arrest

Therapeutic hypothermia is one of the few interventions that improve mortality and neurologic outcomes in patients who have experienced cardiac arrest. There is a lack of validated tools to predict survival in patients who have undergone hypothermia after cardiac arrest (HACA).

A retrospective analysis was performed of all patients who underwent HACA at Aurora St. Luke's Medical Center (ASLMC) since the protocol was implemented in September 2008. Initial rhythm, whether percutaneous coronary intervention (PCI) was performed, lactate levels, duration of resuscitation, and APACHE II scores were compared for survivors and non-survivors, and a logit binary regression model was constructed.

A total of 143 patients were identified and had data abstracted. APACHE-II, duration of resuscitation, and initial rhythm were all strongly correlated with survival. Initial serum lactate levels were higher in non-survivors than survivors (p=0.005), though the trend of lactate change at next draw was not predictive. Quantitative TnI was not significantly different between arms.

Lactate levels show promise as a biomarker for survival in HACA patients resuscitation length, presence of PCI, and APACHE-II scores can provide good prognostic information, even in the early hours following a resuscitation event.