Early lactate elevations following resuscitation from pediatric cardiac arrest are associated with increased mortality*.
OBJECTIVE
To describe the association of lactate levels within the first 12 hours after successful resuscitation from pediatric cardiopulmonary arrest with hospital mortality.


METHODS
Retrospective cohort study.


METHODS
Fifteen children's hospital associated with the Pediatric Emergency Care Applied Research Network.


METHODS
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.


METHODS
None.


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.
1Division 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.
Alexis A
AA
Topjian
Amy E
AE
Clark
T Charles
TC
Casper
John T
JT
Berger
Charles L
CL
Schleien
J Michael
JM
Dean
Frank W
FW
Moler
D000293:Adolescent; D019540:Area Under Curve; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007773:Lactates / Q000097:blood*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D007773:Lactates