title: Evaluation of Serum Lactate, Central Venous Saturation, and Venous-Arterial Carbon Dioxide Difference in the Prediction of Mortality in Postcardiac Arrest Syndrome.
abstract: BACKGROUND
  Tissue hypoperfusion and hypoxia markers predict mortality in critically ill patients. This study evaluates the ability of serum lactate, central venous oxygen saturation (Scvo 2), and venous-arterial carbon dioxide difference (GapCo 2) to predict mortality in patients with postcardiac arrest (post-CA) syndrome.
  
  
  METHODS
  A prospective observational study of patients with post-CA in a tertiary teaching hospital. Serial assessments of lactate, lactate clearance (Clac), GapCo 2, and Scvo 2 in the first 72 hours post-CA were analyzed. Adults (≥18 years) patients resuscitated from CA were included. The primary end point was 28-day mortality and secondary end points were 24- and 72-hour mortality.
  
  
  RESULTS
  A total of 54 patients were recruited, 33 (61,1%) of 54 were men, with a 28-day mortality of 75.9%. Cardiac arrest occurred in-hospital in 84.6% of survivors and 97.5% of nonsurvivors. Lactate and Clac were significantly associated with mortality at 28 days, yielding an area under the receiver-operating characteristic curve of 0.797 (lactate 6 hours) and 0.717 (Clac 6 hours) with a positive predictive value of 96% for lactate 6 hours (> 2.5 mmol/L) and 89.5% for Clac 6 hours (<50%). Survival analysis confirmed the difference between the groups from the 24th hour post-CA. Considering mortality at 24 hours, lactate, Clac, and Scvo 2 (immediately post-CA, 6 and 18 hours) were different between the groups. In mortality at 72 hours, lactate, Clac, Scvo 2 (48 hours), and GapCo 2 (36 and 48 hours) were associated with mortality.
  
  
  CONCLUSIONS
  In post-CA syndrome, serum lactate and Clac were consistently able to predict mortality.
authors.affiliation: Department of Intensive Care, Hospital Cristo Redentor, Grupo Hospitalar Conceição, Porto Alegre-RS, Brazil dmriveiro@yahoo.com.br.
authors.forename: Diego Fontoura Mendes
authors.initials: DF
authors.lastname: Riveiro
authors.affiliation: Department of Intensive Care, Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre-RS, Brazil Department of Intensive Care, Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre-RS, Brazil.
authors.forename: Vanessa Martins de
authors.initials: VM
authors.lastname: Oliveira
authors.affiliation: Department of Intensive Care, Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre-RS, Brazil.
authors.forename: Janete Salles
authors.initials: JS
authors.lastname: Braunner
authors.affiliation: Department of Intensive Care, Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre-RS, Brazil.
authors.forename: Silvia Regina Rios
authors.initials: SR
authors.lastname: Vieira
mesh_terms: D000368:Aged; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000097:blood*; D002302:Cardiac Output; D005260:Female; D006323:Heart Arrest / Q000097:blood* / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011446:Prospective Studies; D012372:ROC Curve; D012151:Resuscitation / Q000401:mortality
chemical_list: D002245:Carbon Dioxide; D019344:Lactic Acid
keywords: cardiac arrest; central venous oxygen saturation; lactate; mortality; postresuscitation disease; venous-arterial carbon dioxide difference