title: Severe acidemia on arrival not predictive of neurologic outcomes in post-cardiac arrest patients.
abstract: OBJECTIVE
  This study aimed to determine whether severe acidemia (pH <7.2) on arrival at the emergency department (ED) is a predictive factor for neurologic outcomes of post-cardiac arrest patients treated with targeted temperature management (TTM).
  
  
  METHODS
  Data in the National Disaster Medical Center, a tertiary care hospital, were used to perform a case-control study on post-cardiac arrest patients treated with TTM from January 2013 to April 2015. The case group comprised patients with good neurologic outcomes (cerebral performance categories 1 and 2), whereas the control group comprised patients with poor neurologic outcomes (cerebral performance categories 3-5). Exposure was defined as arterial pH less than 7.2 on arrival at the ED.
  
  
  RESULTS
  We identified 32 patients matching our criteria, of which 13 had good outcomes and 19 poor outcomes. Arterial pH on arrival was not significantly associated with neurologic outcomes (P = .47; odds ratio, 0.5; 95% confidence interval, 0.09-2.61). In 24 patients with cardiogenic causes of cardiac arrest, pH on arrival was not significantly associated with neurologic outcomes (P = .68; odds ratio, 0.5; 95% confidence interval, 0.09-2.73) after matched-pair analysis by age, sex, and presence of light reflex.
  
  
  CONCLUSIONS
  Severe acidemia on arrival at the ED is not a significant predictive factor for neurologic outcomes in post-cardiac arrest patients treated with TTM, particularly in patients with cardiogenic causes of cardiac arrest. These results suggest that treatment should not be withheld in post-cardiac arrest patients with severe acidemia.
authors.affiliation: Department of Critical Care Medicine and Trauma, National Disaster Medical Center, 3256 Tachikawa City, Tokyo, Japan. Electronic address: ken-tetsuhara@mti.biglobe.ne.jp.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Tetsuhara
authors.affiliation: Department of Critical Care Medicine and Trauma, National Disaster Medical Center, 3256 Tachikawa City, Tokyo, Japan. Electronic address: hiromayu@mub.biglobe.ne.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kato
authors.affiliation: Department of Critical Care Medicine and Trauma, National Disaster Medical Center, 3256 Tachikawa City, Tokyo, Japan. Electronic address: t-kane@qk2.so-net.ne.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanemura
authors.affiliation: Department of Critical Care Medicine and Trauma, National Disaster Medical Center, 3256 Tachikawa City, Tokyo, Japan. Electronic address: Ichiroh1974@gmail.com.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Okada
authors.affiliation: Department of Critical Care Medicine and Trauma, National Disaster Medical Center, 3256 Tachikawa City, Tokyo, Japan. Electronic address: nobuaki.kiriu@gmail.com.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Kiriu
mesh_terms: D018806:APACHE; D000138:Acidosis / Q000150:complications*; D000368:Aged; D001784:Blood Gas Analysis; D016887:Cardiopulmonary Resuscitation; D016022:Case-Control Studies; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007036:Hypothermia, Induced; D007564:Japan; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology*; D009460:Neurologic Examination; D058687:Out-of-Hospital Cardiac Arrest / Q000097:blood* / Q000628:therapy*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome