title: The association between post resuscitation hemoglobin level and survival with good neurological outcome following Out Of Hospital cardiac arrest.
abstract: OBJECTIVE
  to explore the association between post return of spontaneous circulation (ROSC) hemoglobin level and survival with good neurological outcome following out-of-hospital cardiac arrest.
  
  
  METHODS
  We studied adults with non-traumatic out-of-hospital cardiac arrest who achieved ROSC within 50min of collapse. We quantified the association between post ROSC hemoglobin level and good neurological outcome (defined as Cerebral Performance Category score of 1or 2), using multivariate logistic regression analyses. The impact of Post ROSC hemoglobin level ≥10gdl(-1) and time varying hemoglobin level ≥10gdl(-1) on time to Survival with good outcome was assessed using Cox proportional hazard models.
  
  
  RESULTS
  Of 931 cardiac arrest patients, 146 (16%) achieved ROSC and 30 survived to discharge with a good neurological outcome. Of those with post ROSC hemoglobin level ≥10gdl(-1), 28% (27/98) had good outcome, whereas of those with level <10mgdl(-1) only 6% (3/48) had good outcome (CPC<3, P=0.003). The use of blood transfusions and therapeutic hypothermia were comparable in both good and bad outcome groups. An immediate post ROSC hemoglobin level ≥10gdl(-1) was significantly associated with good neurological outcome (AOR 8.31 95% CI 1.89-36.52 P=0.005). Patients with post ROSC hemoglobin ≥10gdl(-1) were more likely to achieve good outcome earlier (HR 6.02 95% CI 1.75-20.72 P=0.004).
  
  
  CONCLUSIONS
  Post ROSC hemoglobin level ≥10gdl(-1) is associated with survival with good neurological outcome. The importance of time to achieve such level and the role of blood transfusion warrants further investigation.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 5200 Eastern Ave, MFL West 6th Floor, Baltimore, MD 21224, USA. Electronic address: aalbaen1@jhmi.edu.
authors.forename: Aiham
authors.initials: A
authors.lastname: Albaeni
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 5200 Eastern Ave, MFL West 6th Floor, Baltimore, MD 21224, USA.
authors.forename: Shaker M
authors.initials: SM
authors.lastname: Eid
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 5200 Eastern Ave, MFL West 6th Floor, Baltimore, MD 21224, USA.
authors.forename: Bolanle
authors.initials: B
authors.lastname: Akinyele
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 5200 Eastern Ave, MFL West 6th Floor, Baltimore, MD 21224, USA.
authors.forename: Lekshmi Narayan
authors.initials: LN
authors.lastname: Kurup
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 5200 Eastern Ave, MFL West 6th Floor, Baltimore, MD 21224, USA.
authors.forename: Dhananjay
authors.initials: D
authors.lastname: Vaidya
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 5200 Eastern Ave, MFL West 6th Floor, Baltimore, MD 21224, USA.
authors.forename: Nisha
authors.initials: N
authors.lastname: Chandra-Strobos
mesh_terms: D016887:Cardiopulmonary Resuscitation; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009424:Nervous System Physiological Phenomena; D058687:Out-of-Hospital Cardiac Arrest / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins
keywords: Cardiac arrest; Cardiopulmonary resuscitation; Hemoglobin; Sudden death