Veno-arterial CO2 difference and lactate for prediction of early mortality after cardiac arrest

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Veno-arterial CO2 difference and lactate for prediction of early mortality after cardiac arrest

Lundin, Andreas (author): Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för anestesiologi och intensivvård,Institute of Clinical Sciences, Department of Anesthesiology and Intensive care,Univ Gothenburg, Inst Clin Sci, Sahlgrenska Acad, Dept Anaesthesiol & Intens Care Med, Gothenburg, Sweden.,Sahlgrenska Academy

Annborn, Martin (author): Lund University,Lunds universitet,Kliniska Vetenskaper, Helsingborg,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Clinical Sciences, Helsingborg,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Helsingborg Hospital

Borgquist, Ola (author): Lund University,Lunds universitet,Anestesiologi och intensivvård,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Anesthesiology and Intensive Care,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital

Düring, Joachim (author): Lund University,Lunds universitet,Anestesiologi och intensivvård,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Anesthesiology and Intensive Care,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital

Undén, Johan (author): Lund University,Lunds universitet,Anestesiologi och intensivvård,Forskargrupper vid Lunds universitet,Anaesthesiology and Intensive Care Medicine,Lund University Research Groups,Halmstad County Hospital

Rylander, Christian (author): Uppsala University,Uppsala universitet,Anestesiologi och intensivvård

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2023-03-16
2023
English.
In: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 67:5, s. 655-662

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Journal article (peer-reviewed)

Abstract Subject headings

Patients admitted to intensive care after cardiac arrest are at risk of circulatory shock and early mortality due to cardiovascular failure. The aim of this study was to evaluate the ability of the veno-arterial pCO(2) difference ( increment pCO(2); central venous CO2 - arterial CO2) and lactate to predict early mortality in postcardiac arrest patients. This was a pre-planned prospective observational sub-study of the target temperature management 2 trial. The sub-study patients were included at five Swedish sites. Repeated measurements of increment pCO(2) and lactate were conducted at 4, 8, 12, 16, 24, 48, and 72 h after randomization. We assessed the association between each marker and 96-h mortality and their prognostic value for 96-h mortality. One hundred sixty-three patients were included in the analysis. Mortality at 96 h was 17%. During the initial 24 h, there was no difference in increment pCO(2) levels between 96-h survivors and non-survivors. increment pCO(2) measured at 4 h was associated with an increased risk of death within 96 h (adjusted odds ratio: 1.15; 95% confidence interval [CI]: 1.02-1.29; p = .018). Lactate levels were associated with poor outcome over multiple measurements. The area under the receiving operating curve to predict death within 96 h was 0.59 (95% CI: 0.48-0.74) and 0.82 (95% CI: 0.72-0.92) for increment pCO(2) and lactate, respectively. Our results do not support the use of increment pCO(2) to identify patients with early mortality in the postresuscitation phase. In contrast, non-survivors demonstrated higher lactate levels in the initial phase and lactate identified patients with early mortality with moderate accuracy.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)

Keyword

cardiac arrest
postresuscitation care
prognosis
veno-arterial pCO(2)
gap
cardiac arrest
veno-arterial pCO gap

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ref (subject category)
art (subject category)

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By the author/editor: Lundin, Andreas; Annborn, Martin; Borgquist, Ola; Düring, Joachim; Undén, Johan; Rylander, Christ ...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Anesthesiology a ...

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By the university: University of Gothenburg; Uppsala University; Lund University

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