Intensive Care Medicine

, Volume 23, Issue 11, pp 1138–1143 | Cite as

The association between blood lactate concentration on admission, duration of cardiac arrest, and functional neurological recovery in patients resuscitated from ventricular fibrillation

  • M. Müllner
  • F. Sterz
  • H. Domanovits
  • W. Behringer
  • M. Binder
  • A. N. Laggner
Original

Abstract

Objective

To assess the association between arterial lactate concentration on admission and the duration of human ventricular fibrillation cardiac arrest, and to what degree the arterial lactate concentration on admission is an early predictor of functional neurological recovery in human cardiac arrest survivors.

Design

Cohort study. Arterial lactate concentrations and out-of-hospital data concerning cardiac arrest and cardiopulmonary resuscitation were collected retrospectively according to a standardized protocol. Functional neurological recovery was assessed prospectively at regular intervals for 6 months.

Setting

Emergency department of an urban tertiary care hospital.

Patients

A total of 167 primary survivors of witnessed out-of-hospital ventricular fibrillation cardiac arrest.

Measurements

The association between arterial lactate concentration on admission, the duration of cardiac arrest, and functional neurological recovery was assessed. Further, we assessed whether admission concentrations of arterial lactate and duration of cardiac arrest can predict unfavorable functional neurological recovery. Functional neurological recovery was measured in cerebral performance categories (CPC). No or minimal functional impairment (CPC 1 and 2) was defined as favorable outcome; the remaining categories (CPC 3, 4 and 5) were defined as unfavorable functional neurological recovery.

Results

In 167 patients, a weak association between total duration of cardiac arrest and admission levels of lactate (r=0.49, P<0.001) could be shown. With increasing admission concentrations of arterial lactate functional neurological recovery was more likely to be unfavorable (OR 1.15 per mmol/1 increase, 95 % CI 1.04–1.27). Nevertheless, only at very high levels of lactate (16.3 mmol/1) could unfavorable neurological recovery be detected with 100 % specificity, yielding a very low sensitivity of 16 %.

Conclusions

The arterial admission lactate concentration after out-of-hospital ventricular fibrillation cardiac arrest is a weak measure of the duration of ischemia. High admission lactate levels are associated with severe neurological impairment. However, this parameter has poor prognostic value for individual estimation of the severity of subsequent functional neurological impairment.

Key words

Cardiac arrest Cardiopulmonary resuscitation Outcome Lactate 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Mizock BA, Falk JL (1992) Lactic acidosis in critical illness. Crit Care Med 20: 80–93PubMedCrossRefGoogle Scholar
  2. 2.
    Mizock BA (1987) Controversies in lactic acidosis. Implications in critically ill patients. JAMA 258: 497–501PubMedGoogle Scholar
  3. 3.
    Beuret P, Feihl F, Vogt P, et al (1993) Cardiac arrest: prognostic factors and outcome at one year. Resuscitation 25: 171–179PubMedCrossRefGoogle Scholar
  4. 4.
    Bialecki L, Woodward RS (1995) Predicting death after CPR. Experience at a nonteaching community hospital with a full-time critical care staff. Chest 108: 1009–1017PubMedCrossRefGoogle Scholar
  5. 5.
    Martens PR, Mullie A, Calle P, Van Hoeyweghen R (1993) Influence on outcome after cardiac arrest of time elapsed between call for help and start of bystander basic CPR. The Belgian Cerebral Resuscitation Group. Resuscitation 25:227–234PubMedCrossRefGoogle Scholar
  6. 6.
    Rogove HJ, Safar P, Sutton-Tyrrell K, Abramson NS, Brain Resuscitation Clinical Trial I and II Study Groups (1995) Old age does not negate good cerebral outcome after cardiopulmonary resuscitation: analyses from the brain resuscitation clinical trials. Crit Care Med 23:18–25PubMedCrossRefGoogle Scholar
  7. 7.
    Carden DL, Martin GB, Nowak RM, et al (1985) Lactic acidosis as a predictor of downtime during cardiopulmonary arrest in dogs. Am J Emerg Med 3:120–124PubMedCrossRefGoogle Scholar
  8. 8.
    Carden DL, Martin GB, Nowak RM, et al (1987) Lactic acidosis during closed-chest CPR in dogs. Ann Emerg Med 16:1317–1320PubMedCrossRefGoogle Scholar
  9. 9.
    Carden DL, Martin GB, Nowak RM, et al (1989) The effect of cardiopulmonary bypass resuscitation on cardiac arrest induced lactic acidosis in dogs. Resuscitation 17:153–161PubMedCrossRefGoogle Scholar
  10. 10.
    Herlitz J, Ekström L, Wennerblom B, Axelsson Å, Bång A, Holmberg S (1994) Predictors of early and late survival after out-of-hospital cardiac arrest in which asystole was the first recorded arrhythmia on scene. Resuscitation 28: 27–36PubMedCrossRefGoogle Scholar
  11. 11.
    Task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada and the Australian Resuscitation Council (1991) Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. Circulation 84:960–975Google Scholar
  12. 12.
    European Resuscitation Council (1992) Guidelines for basic and advanced life support. Resuscitation 24:102–110Google Scholar
  13. 13.
    Brain Resuscitation Clinical Trial I Study Group (1986) A randomized clinical study of cardiopulmonary-cerebral resuscitation: design, methods, and patient characteristics. Am J Emerg Med 4:72–86CrossRefGoogle Scholar
  14. 14.
    Safar P (1993) Cerebral resuscitation after cardiac arrest: research initiatives and future directions. Ann Emerg Med 22: 324–349PubMedCrossRefGoogle Scholar
  15. 15.
    Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet I:480–484CrossRefGoogle Scholar
  16. 16.
    Rivers EP, Wortsman J, Rady MY, et al (1994) The effect of the total cumulative epinephrine dose administered during human CPR on hemodynamic, oxygen transport, and utilization variables in the postresuscitation period. Chest 106:1499–1507PubMedCrossRefGoogle Scholar
  17. 17.
    Clutter WE, Bier DM, Shah SD, Cryer PE (1980) Epinephrine plasma metabolic clearance and physiologic thresholds for metabolic and hemodynamic actions in man. J Clin Invest 66: 94–101PubMedCrossRefGoogle Scholar
  18. 18.
    Zweig MH, Campbell G (1993) Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem 39: 561–577PubMedGoogle Scholar
  19. 19.
    Armitage P, Berry G (1994) Diagnostic tests and screening procedures. In: Armitage P, Berry G (eds) Statistical methods in medical research. Blackwell Scientific, Oxford, pp 522–529Google Scholar
  20. 20.
    Leavy JA, Weil MH, Rackow EC (1988) “Lactate washout” following circulatory arrest. JAMA 260: 662–664PubMedCrossRefGoogle Scholar
  21. 21.
    Beer RJ, Teasdale TA, Ghusn HF, Taffet GE (1994) Estimation of severity of illness with APACHE II: age-related implications in cardiac arrest outcomes. Resuscitation 27:189–195PubMedCrossRefGoogle Scholar
  22. 22.
    Hallstrom AP, Cobb LA, Yu BH (1996) Influence of comorbidity on the outcome of patients treated for out-of-hospital ventricular fibrillation. Circulation 93:2019–2022PubMedGoogle Scholar
  23. 23.
    Mullie A, Lewi P, Van Hoeyweghen R (1989) Pre-CPR conditions and the final outcome of CPR. The Cerebral Resuscitation Group. Resuscitation 17 [Suppl]:S11–21PubMedCrossRefGoogle Scholar
  24. 24.
    Halperin ML, Fields AL (1985) Lactic acidosis — emphasis on the carbon precursors and buffering of the acid load. Am J Med Sci 289:154–159PubMedCrossRefGoogle Scholar
  25. 25.
    Rivers EP, Rady MY, Martin GB, et al (1992) Venous hyperoxia after cardiac arrest. Characterization of a defect in systemic oxygen utilization. Chest 102: 1787–1793PubMedCrossRefGoogle Scholar
  26. 26.
    Negovsky VA, Gurvich AM (1995) Post-resuscitation disease — a new nosological entity. Its reality and significance. Resuscitation 30: 23–27PubMedCrossRefGoogle Scholar
  27. 27.
    Cohan SL, Mun SK, Petite J, et al (1989) Cerebral blood flow in humans following resuscitation from cardiac arrest. Stroke 20: 761–765PubMedGoogle Scholar
  28. 28.
    Fischer EG, Ames A III, Lorenzo AV (1979) Cerebral blood flow immediately following brief circulatory stasis. Stroke 10: 423–427PubMedGoogle Scholar
  29. 29.
    Sterz F, Leonov Y, Safar P, et al (1992) Multifocal cerebral blood flow by Xe-CT and global cerebral metabolism after prolonged cardiac arrest in dogs. Re-perfusion with open-chest CPR or cardiopulmonary bypass. Resuscitation 24: 27–47PubMedCrossRefGoogle Scholar
  30. 30.
    Oku K, Kuboyama K, Safar P, et al (1994) Cerebral and systemic arteriovenous oxygen monitoring after cardiac arrest. Inadequate cerebral oxygen delivery. Resuscitation 27:141–152PubMedCrossRefGoogle Scholar
  31. 31.
    Müllner M, Sterz F, Zeiner A, et al (1996) Systemic and cerebral oxygen extraction after human cardiac arrest. Eur J Emerg Med 3:19–24PubMedCrossRefGoogle Scholar
  32. 32.
    Zarzuelo R, Castañeda J (1995) Differences in oxygen content between mixed venous blood and cerebral venous blood for outcome prediction after cardiac arrest. Intensive Care Med 21: 71–75PubMedCrossRefGoogle Scholar
  33. 33.
    Müllner M, Sterz F, Binder M, et tal (1996) Arterial hypertension early after human cardiac arrest and neurological recovery. Stroke 27: 59–62PubMedGoogle Scholar
  34. 34.
    Vincent JL, Dufaye P, Berré J, et al (1983) Serial lactate determinations during circulatory shock. Crit Care Med 11: 449–451PubMedCrossRefGoogle Scholar
  35. 35.
    Tashkin DP, Goldstein PJ, Simmons DH (1972) Hepatic lactate uptake during decreased liver perfusion and hypoxemia. Am J Physiol 223: 968–974PubMedGoogle Scholar
  36. 36.
    Herlitz J, Ekström L, Wennerblom B, Axelsson Å, Bång A, Holmberg S (1995) Hospital mortality after out-of-hospital cardiac arrest among patients found in ventricular fibrillation. Resuscitation. 29:11–21PubMedCrossRefGoogle Scholar
  37. 37.
    Kimman GP, Ivens EMA, Hartman JAM, Hart HN, Simoons ML (1994) Long-term survival after successful out-of-hospital resuscitation. Resuscitation 28:227–232PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 1997

Authors and Affiliations

  • M. Müllner
    • 1
  • F. Sterz
    • 1
  • H. Domanovits
    • 1
  • W. Behringer
    • 1
  • M. Binder
    • 2
  • A. N. Laggner
    • 1
  1. 1.Department of Emergency MedicineVienna General Hospital - University of Vienna, Medical SchoolViennaAustria
  2. 2.Department of DermatologyVienna General Hospital - University of Vienna, Medical SchoolViennaAustria

Personalised recommendations