Targeted temperature management guided by the severity of hyperlactatemia for out-of-hospital cardiac arrest patients: a post hoc analysis of a nationwide, multicenter prospective registry

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URI http://shark.lib.kagawa-u.ac.jp/kuir/metadata/28994
Title
Targeted temperature management guided by the severity of hyperlactatemia for out-of-hospital cardiac arrest patients: a post hoc analysis of a nationwide, multicenter prospective registry
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Description

Abstract

Background: The International Liaison Committee on Resuscitation guidelines recommend target temperature management (TTM) between 32 and 36 °C for patients after out-of-hospital cardiac arrest, but did not indicate patient-specific temperatures. The association of serum lactate concentration and neurological outcome in out-of-hospital cardiac arrest patient has been reported. The study aim was to investigate the benefit of 32-34 °C in patients with various degrees of hyperlactatemia compared to 35-36 °C.

Methods: This study was a post hoc analysis of the Japanese Association for Acute Medicine out-of-hospital cardiac arrest registry between June 2014 and December 2015. Patients with complete targeted temperature management and lactate data were eligible. Patients were stratified to mild (< 7 mmol/l), moderate (< 12 mmol/l), or severe (≥ 12 mmol/l) hyperlactatemia group based on lactate concentration after return of spontaneous circulation. They were subdivided into 32-34 °C or 35-36 °C groups. The primary endpoint was an adjusted predicted probability of 30-day favorable neurological outcome, defined as a cerebral performance category score of 1 or 2.

Result: Of 435 patients, 139 had mild, 182 had moderate, and 114 had severe hyperlactatemia. One hundred and eight (78%) with mild, 128 with moderate (70%), and 83 with severe hyperlactatemia (73%) received TTM at 32-34 °C. The adjusted predicted probability of a 30-day favorable neurological outcome following severe hyperlactatemia was significantly greater with 32-34 °C (27.4%, 95% confidence interval: 22.0-32.8%) than 35-36 °C (12.4%, 95% CI 3.5-21.2%; p = 0.005). The differences in outcomes in those with mild and moderate hyperlactatemia were not significant.

Conclusions: In OHCA patients with severe hyperlactatemia, the adjusted predicted probability of 30-day favorable neurological outcome was greater with TTM at 32-34 °C than with TTM at 35-36 °C. Further evaluation is needed to determine whether TTM at 32-34 °C can improve neurological outcomes in patients with severe hyperlactatemia after out-of-hospital cardiac arrest.

Keywords:

Hyperlactatemia; Out-of-hospital cardiac arrest; Targeted temperature management

(医博甲747)

Author
著者 岡﨑 智哉
著者(ヨミ) オカザキ トモヤ
著者(別表記) Okazaki Tomoya
Publication Title
Annals of intensive care
Publication Title Alternative
Ann Intensive Care.
Volume
9
Issue
1
Publisher
French Society of Intensive Care
BMC
Springer
Published Date
2019-11-19
ISSN
2110-5820
PMID
31745738
DOI
10.1186/s13613-019-0603-y
Resource Type
Thesis or Dissertation
Language
eng
Relation
PMCID: PMC6864017
Resource URL
https://doi.org/10.1186/s13613-019-0603-y
http://www.ncbi.nlm.nih.gov/pmc/articles/pmc6864017/
Rights
Copyright © The Author(s) 2019
"This is the Publisher's Version of the following article: Targeted temperature management guided by the severity of hyperlactatemia for out-of-hospital cardiac arrest patients: a post hoc analysis of a nationwide, multicenter prospective registry; Annals of intensive care; Volume 9 Number 1 (2019) Article number 127; doi: 10.1186/s13613-019-0603-y, which has been published in final form at https://doi.org/10.1186/s13613-019-0603-y . "
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Text Version
ETD
Grant ID
博甲第747号
Grant Date
2020-03-24
Degree Name
博士(医学)
Grantor
香川大学
Set
香川大学
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