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Early prognostic impact of serum sodium level among out-of-hospital cardiac arrest patients: a nationwide multicentre observational study in Japan (the JAAM-OHCA registry)

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Abstract

Dysnatremia is an electrolytic disorder commonly associated with mortality in various diseases. However, little is known about dysnatremia in out-of-hospital cardiac arrest (OHCA) cases. Here, we investigated the association between serum sodium level on hospital arrival and neurological outcomes after OHCA. This nationwide hospital-based observational study (The Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest registry) enrolled patients with OHCA between 2014 and 2017. We included adult patients aged ≥ 18 years with non-traumatic OHCA who achieved return of spontaneous circulation (ROSC) and whose serum sodium level on hospital arrival was available. Based on the serum sodium level, patients were divided into three levels: hyponatremia (Na < 135 mEq/L), normal sodium level (Na ≥ 135 or ≤ 145 mEq/L), and hypernatremia (Na > 145 mEq/L). The primary outcome was 1-month survival with favourable neurological outcomes. Altogether, 34 754 patients with OHCA were documented, and 5160 patients with non-traumatic OHCA and who achieved ROSC were eligible for our analyses. The proportion of favourable neurological outcomes was highest in patients with normal sodium levels at 17.6% (677/3854), followed by patients with hyponatremia at 8.2% (57/696) and patients with hypernatremia at 5.7% (35/610). Moreover, hyponatremia and hypernatremia were associated with a decreased probability of favourable neurological outcomes compared with normal sodium level (vs. hyponatremia, adjusted odds ratio [AOR] 0.97, 95% confidence interval [CI] 0.95–0.99; vs. hypernatremia, AOR 0.96, 95% CI 0.94–0.98). Hypo- and hypernatremia on hospital arrival were associated with a decreased probability of favourable neurological outcomes in patients with non-traumatic OHCA who achieved ROSC.

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Acknowledgements

We are deeply indebted to all members of the CRITICAL study group for their contributions. We are also deeply grateful to all of the EMS personnel for collecting Utstein data and to Ms. Ikuko Nakamura for supporting the CRITICAL study. The authors thank their colleagues from the Osaka University Centre of Medical Data Science and Advanced Clinical Epidemiology Investigator’s Research Project for providing insight and expertise to our research.

Haruka Shida, one of the authors, currently does not belong to the School of Public Health, Kyoto University. This research was completed when she belonged to the School of Public Health, Kyoto University, and her current affiliation (Pharmaceuticals and Medical Devices Agency) did not have any relationship with this research.

Funding

This study was supported by a scientific research grant from the Japan Ministry of Education, Culture, Sports, Science, and Technology (16K09034 and 19K09393).

Author information

Authors and Affiliations

  1. Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan

    Haruka Shida, Norihiro Nishioka, Yohei Okada, Satoshi Yoshimura, Shunsuke Kimata, Shunsuke Kawai & Yuto Makino

  2. Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan

    Tasuku Matsuyama

  3. Division of Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan

    Sho Komukai

  4. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan

    Taro Irisawa

  5. Emergency and Critical Care Medical Center, Osaka Police Hospital, Osaka, Japan

    Tomoki Yamada

  6. Department of Emergency and Critical Care Medicine, Kansai Medical University, Takii Hospital, Moriguchi, Japan

    Kazuhisa Yoshiya

  7. Department of Emergency Medicine, Tane General Hospital, Osaka, Japan

    Changhwi Park

  8. Department of Critical Care Medicine, Osaka City University, Osaka, Japan

    Tetsuro Nishimura

  9. Department of Emergency and Critical Care Medicine, Kindai University Faculty of Medicine, Osaka-Sayama, Japan

    Takuya Ishibe

  10. Osaka Mishima Emergency Critical Care Center, Takatsuki, Japan

    Yoshiki Yagi

  11. Critical Care and Trauma Center, Osaka General Medical Center, Osaka, Japan

    Takeyuki Kiguchi

  12. Osaka Prefectural Nakakawachi Medical Center of Acute Medicine, Higashi-Osaka, Japan

    Masafumi Kishimoto

  13. Senshu Trauma and Critical Care Center, Osaka, Japan

    Sung-Ho Kim

  14. Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Japan

    Yasuyuki Hayashi

  15. Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan

    Taku Sogabe

  16. Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan

    Takaya Morooka

  17. Department of Pediatrics, Osaka Red Cross Hospital, Osaka, Japan

    Haruko Sakamoto

  18. Emergency and Critical Care Medical Center, Kishiwada Tokushukai Hospital, Osaka, Japan

    Keitaro Suzuki

  19. Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan

    Fumiko Nakamura

  20. Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan

    Satoshi Matsui & Tetsuhisa Kitamura

  21. Kyoto University Health Services, Kyoto, Japan

    Taku Iwami

  22. Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Chiyoda-ku, Tokyo, Japan

    Haruka Shida

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  1. Haruka Shida
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  2. Tasuku Matsuyama
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  3. Sho Komukai
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  4. Taro Irisawa
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  8. Tetsuro Nishimura
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  9. Takuya Ishibe
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  18. Keitaro Suzuki
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  27. Taku Iwami
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  28. Tetsuhisa Kitamura
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Shida, H., Matsuyama, T., Komukai, S. et al. Early prognostic impact of serum sodium level among out-of-hospital cardiac arrest patients: a nationwide multicentre observational study in Japan (the JAAM-OHCA registry). Heart Vessels 37, 1255–1264 (2022). https://doi.org/10.1007/s00380-022-02020-3

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