Internal and Emergency Medicine

, Volume 11, Issue 5, pp 727–736 | Cite as

Association between hemoglobin levels and clinical outcomes in adult patients after in-hospital cardiac arrest: a retrospective cohort study

  • Chih-Hung Wang
  • Chien-Hua Huang
  • Wei-Tien Chang
  • Min-Shan Tsai
  • Ping-Hsun Yu
  • An-Yi Wang
  • Nai-Chuan Chen
  • Wen-Jone Chen
EM - ORIGINAL

Abstract

In addition to cardiac output, oxygen delivery is determined by the amount of oxygen carried by hemoglobin, which is estimated by the product of hemoglobin level and peripheral hemoglobin oxygen saturation (SpO2). Optimal hemoglobin concentration for post-cardiac arrest syndrome (PCAS) has not yet been investigated thoroughly. We conducted a retrospective observational study in a single medical center. We included adult patients between 2006 and 2012 who experienced in-hospital cardiac arrest, and achieved sustained return of spontaneous circulation (ROSC). We used multivariable logistic regression analysis to identify factors associated with favorable neurological status at hospital discharge, defined as a score of 1 or 2 on the Cerebral Performance Category scale. Minimum hemoglobin concentration and SpO2 during the initial 24 h after ROSC were used for analysis. Anemia was defined by the World Health Organization criteria as a hemoglobin concentration <12 g/dL in women and <13 g/dL in men. Of the 426 patients included in our analysis, 387 patients (90.8 %) met the criteria for anemia. The mean minimum hemoglobin concentration among all the patients was 9.2 g/dL. The product of hemoglobin × SpO2 was correlated with a favorable neurological outcome (odds ratio 1.003, 95 % confidence interval 1.002–1.004). According to recommended SpO2 by resuscitation guidelines (94–98 %), we calculated the corresponding range of minimum required hemoglobin concentration to be 8.6–9.0 g/dL for a favorable neurological outcome. Anemia common among PCAS patients. Neurological outcome in PCAS might be correlated with hemoglobin concentration following resuscitation.

Keywords

Heart arrest Cardiopulmonary resuscitation Emergency medicine Critical care Oxygen Hemoglobin 

Supplementary material

11739_2015_1386_MOESM1_ESM.tif (24 kb)
Supplemental Fig 1Generalized additive model plot for nonparametric modelling of the effect of PaO2 on the logit of probability for a favorable neurological outcome at hospital discharge. PaO2, arterial oxygen partial pressure (TIFF 23 kb)
11739_2015_1386_MOESM2_ESM.docx (18 kb)
Supplementary material 2 (DOCX 18 kb)

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Copyright information

© SIMI 2016

Authors and Affiliations

  • Chih-Hung Wang
    • 1
    • 2
    • 3
  • Chien-Hua Huang
    • 3
  • Wei-Tien Chang
    • 3
  • Min-Shan Tsai
    • 3
  • Ping-Hsun Yu
    • 4
  • An-Yi Wang
    • 3
  • Nai-Chuan Chen
    • 5
  • Wen-Jone Chen
    • 3
    • 6
  1. 1.Department of Emergency MedicineNational Taiwan University Hospital Yunlin BranchDouliu CityTaiwan, ROC
  2. 2.Graduate Institute of Clinical Medicine, College of MedicineNational Taiwan UniversityTaipei CityTaiwan, ROC
  3. 3.Department of Emergency Medicine, National Taiwan University College of MedicineNational Taiwan University HospitalTaipei CityTaiwan, ROC
  4. 4.Department of Emergency Medicine, Taipei HospitalMinistry of Health and WelfareNew Taipei CityTaiwan, ROC
  5. 5.Department of Emergency Medicine, Tao Yuan General HospitalMinistry of Health and WelfareTaoyuan CityTaiwan, ROC
  6. 6.Department of Emergency MedicineLotung Poh-Ai HospitalYilan CountyTaiwan, ROC

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