title: Association of brain metabolites with blood lactate and glucose levels with respect to neurological outcomes after out-of-hospital cardiac arrest: A preliminary microdialysis study.
abstract: Out-of-hospital cardiac arrest (OHCA) is associated with poor prognosis. Cerebral microdialysis (CMD) is an efficient sampling technique to detect neurochemical changes in brain interstitial tissue. In this retrospective study, we hypothesised that there are different CMD levels between patients with favourable and unfavourable neurological outcomes.
  
  
  
  Data of patients with OHCA admitted to Kagawa University Hospital and administered therapeutic hypothermia (TH) were collected. Using a CMD probe, extracellular glucose, lactate and pyruvate levels were measured hourly along with intracranial perfusion pressure (ICP) and cerebral perfusion pressure (CPP) for the initial 72h during TH. The lactate/pyruvate (LP) ratio was calculated. Patients were divided into favourable [Glasgow-Pittsburgh cerebral performance category 1-2 at 30days after cardiac arrest] or unfavourable neurological outcome groups. CMD biochemical markers and blood lactate and glucose levels were compared between two groups.
  
  
  
  Ten patients were included. ICP was significantly higher in the unfavourable than in the favourable neurological outcome group; there were no significant differences with respect to CPP. The CMD LP ratio in the unfavourable outcome group progressively increased; significant differences were observed on days 2, 3 and 4 (p<0.01). Significant differences in blood lactate levels were observed between the groups only on day 3.5. CMD and blood glucose levels were higher in the unfavourable than in the favourable outcome group during TH.
  
  
  
  The association of CMD levels with long-term outcomes would be better defined in a large randomised prospective study.
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Kita, Miki, Kagawa 761-0793, Japan. Electronic address: hifumitoru@gmail.com.
authors.forename: Toru
authors.initials: T
authors.lastname: Hifumi
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Kita, Miki, Kagawa 761-0793, Japan.
authors.forename: Kenya
authors.initials: K
authors.lastname: Kawakita
authors.affiliation: Department of Public Health, Kagawa University Hospital, 1750-1 Ikenobe, Kita, Miki, Kagawa 761-0793, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yoda
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Kita, Miki, Kagawa 761-0793, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Okazaki
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Kita, Miki, Kagawa 761-0793, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kuroda
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis*; D001921:Brain / Q000378:metabolism*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D007564:Japan; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D017551:Microdialysis / Q000379:methods*; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology / Q000378:metabolism; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000378:metabolism / Q000628:therapy; D011379:Prognosis; D015203:Reproducibility of Results; D013223:Statistics as Topic
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D019344:Lactic Acid
keywords: Glucose; Lactate; Microdialysis; Neurological outcome; Post cardiac arrest syndrome