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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Prognostic implications of blood lactate concentrations after cardiac arrest: a retrospective study
Antonio Maria Dell'Anna1,2, Claudio Sandroni2, Irene Lamanna1
1Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
Insights
High lactate levels after cardiac arrest predict poor neurological recovery. Factors like vasopressor use and kidney function influence these lactate levels, impacting patient outcomes.
Area of Science:
- Critical Care Medicine
- Neurology
- Biochemistry
Background:
- Elevated blood lactate is linked to higher mortality following cardiac arrest (CA).
- Understanding factors influencing lactate levels and their impact on neurological recovery is crucial.
Purpose of the Study:
- To identify variables associated with high blood lactate concentrations post-CA.
- To explore the relationship between blood lactate levels and neurological outcomes.
Main Methods:
- Retrospective analysis of adult patients resuscitated from CA and admitted to ICU.
- Lactate concentrations measured at multiple time points (admission, 6, 12, 24, 48 hours).
- Neurological outcome assessed at 3 months using Cerebral Performance Category (CPC) score.
Main Results:
- 162 out of 236 patients (69%) experienced poor neurological outcomes.
- Higher admission lactate and cSOFA scores were observed in patients with poor outcomes.
- High admission lactate independently predicted poor neurological recovery (OR 1.18).
Conclusions:
- Admission lactate concentration is an independent predictor of poor neurological recovery after CA.
- Factors such as vasopressor use, high PaO2, prolonged resuscitation, and renal dysfunction predict high lactate levels.
Background:
Elevated lactate concentration has been associated with increased mortality after out-of-hospital cardiac arrest (CA). We investigated the variables associated with high blood lactate concentrations and explored the relationship between blood lactate and neurological outcome in this setting.
Methods:
This was a retrospective analysis of an institutional database that included all adult (> 18 years) patients admitted to a multidisciplinary Department of Intensive Care between January 2009 and January 2013 after resuscitation from CA. Blood lactate concentrations were collected at hospital admission and 6, 12, 24 and 48 h thereafter. Neurological outcome was evaluated 3 months post-CA using the Cerebral Performance Category (CPC) score: a CPC of 3-5 was used to define a poor outcome.
Results:
Of the 236 patients included, 162 (69%) had a poor outcome. On admission, median lactate concentrations (5.3[2.9-9.0] vs. 2.5[1.5-5.5], p < 0.001) and cardiovascular sequential organ failure assessment (cSOFA) score (3[0-4] vs. 0[0-3], p = 0.003) were higher in patients with poor than in those with favourable outcomes. Lactate concentrations were higher in patients with poor outcomes at all time points. Lactate concentrations were similar in patients with out-of-hospital and in-hospital CA at all time points. After adjustment, high admission lactate was independently associated with a poor neurological outcome (OR 1.18, 95% CI 1.08-1.30; p < 0.001). In multivariable analysis, use of vasopressors and high PaO2 on admission, longer time to return of spontaneous circulation and altered renal function were associated with high admission lactate concentrations.
Conclusions:
High lactate concentrations on admission were an independent predictor of poor neurological recovery post-CA, but the time course was not related to outcome. Prolonged resuscitation, use of vasopressors, high PaO2 and altered renal function were predictors of high lactate concentrations.
