Cerebral lactate uptake during cardiopulmonary resuscitation in humans.
Animal studies have shown cerebral lactate uptake under conditions of anoxia and ischemia. Cerebral lactate uptake in humans during cardiopulmonary resuscitation (CPR) has not been previously reported in the literature. Forty-five patients receiving CPR underwent simultaneous sampling through jugular venous bulb, right atrial, and central aortic catheterization. The mean net cerebral lactate uptake (central aortic minus jugular venous bulb) was 0.76 +/- 1.86 and 0.80 +/- 2.03 mM on initial measurement and 10 min later, respectively. Both measurements were statistically significant (p = 0.01) compared to normal controls who have net cerebral output of lactate of -0.18 +/- 0.1 mM. Seventy-one percent of all patients had a cerebral uptake on initial sampling and this gradient persisted upon sampling 10 min later in 68% of the remaining 40 patients who did not have a return of spontaneous circulation. Among multiple variables measured, patients who exhibited a cerebral lactate uptake were 13.2 years younger (p = 0.004), received an additional 7.6 min of CPR (p = 0.05), and had a mean arterial lactate concentration of 4.8 mM higher (p = 0.005) than the nonuptake group. The pathophysiologic explanation of cerebral lactate uptake during CPR is multifactorial and includes utilization and/or diffusion.
Rivers
E P
EP
Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan 48202.
Paradis
N A
NA
Martin
G B
GB
Goetting
M E
ME
Rosenberg
J A
JA
Smithline
H A
HA
Appleton
T J
TJ
Nowak
R M
RM
D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D001158:Arteries; D001921:Brain / Q000378:metabolism*; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D007601:Jugular Veins; D007773:Lactates / Q000097:blood / Q000378:metabolism*; D019344:Lactic Acid; D008875:Middle Aged; D012151:Resuscitation
D007773:Lactates; D019344:Lactic Acid