Early Lactate Clearance Is Associated With Improved Outcomes in Patients With Postcardiac Arrest Syndrome: A Prospective, Multicenter Observational Study (SOS-KANTO 2012 Study).
OBJECTIVE
To determine whether early lactate reduction is associated with improved survival and good neurologic outcome in patients with out-of-hospital cardiac arrest.


METHODS
Ad hoc data analysis of a prospective, multicenter observational study.


METHODS
Out-of-hospital cardiac arrest patients at 67 emergency hospitals in Kanto, Japan between January 2012 and March 2013.


METHODS
Adult patients with out-of-hospital cardiac arrest admitted to the hospital after successful resuscitation were identified.


METHODS
Blood lactate concentrations were measured at hospital admission and 6 h after hospital admission. Early lactate clearance was defined as the percent change in lactate level 6 h after a baseline measurement.


RESULTS
The 543 patients (mean age, 65 ± 16 yr; 72.6% male) had a mean lactate clearance of 42.4% ± 53.7%. Overall 30-day survival and good neurologic outcome were 47.1% and 27.4%, respectively. The survival proportion increased with increasing lactate clearance (quartile 1, 29.4%; quartile 2, 42.6%; quartile 3, 51.5%; quartile 4, 65.2%; p < 0.001). Multivariate logistic regression analysis showed that lactate clearance quartile was an independent predictor of the 30-day survival and good neurologic outcome. In the Cox proportional hazards model, the frequency of mortality during 30 days was significantly higher for patients with lactate clearance in quartile 1 (hazard ratio, 3.12; 95% CI, 2.14-4.53), quartile 2 (hazard ratio, 2.13; 95% CI, 1.46-3.11), and quartile 3 (hazard ratio, 1.49; 95% CI, 1.01-2.19) than those with lactate clearance in quartile 4. Furthermore, multivariate logistic regression analysis revealed that lactate clearance was a significant predictor of good neurologic outcome at 30 days after hospital admission.


CONCLUSIONS
Effective lactate reduction over the first 6 hours of postcardiac arrest care was associated with survival and good neurologic outcome independently of the initial lactate level.
1Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, Tokyo, Japan.2Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA.3Department of Biostatistics, School of Public Health, Kyoto University, Yoshida-konoe, Kyoto, Japan.4Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan.5Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Osaka, Japan.6Cardiovascular Center, Nihon University Surugadai Hospital, Chiyoda-ku, Tokyo, Japan.7Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.8Department of Emergency Medicine, Yokohama City University Medical Center, Yokohama-City, Kanagawa, Japan.
Kei
K
Hayashida
Masaru
M
Suzuki
Naohiro
N
Yonemoto
Shingo
S
Hori
Tomoyoshi
T
Tamura
Atsushi
A
Sakurai
Yoshio
Y
Tahara
Ken
K
Nagao
Arino
A
Yaguchi
Naoto
N
Morimura
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D005260:Female; D006801:Humans; D007564:Japan; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012189:Retrospective Studies
D015415:Biomarkers; D019344:Lactic Acid