Key result
Adding metabolic parameters (pH, lactate, base deficit) to peri-arrest factors did not significantly improve the prediction of 30-day good neurological outcome after out-of-hospital cardiac arrest.
Why the study?
Metabolic parameters are routinely added to peri-arrest factors to enhance early outcome prediction in cardiac arrest survivors, but the additional value of this strategy remains unclear.
Does the addition of metabolic parameters to peri-arrest factors improve the prediction of 30-day good neurological function in cardiac arrest survivors?
Observational (n=2,317)
No
Does the addition of metabolic parameters to peri-arrest factors improve the prediction of 30-day good neurological function in cardiac arrest survivors?
Adding initial blood pH, lactate, and base deficit to peri-arrest factors does not improve the prognostication of good neurological outcome in out-of-hospital cardiac arrest survivors.
Answers are grounded in this paper and cite their sources.
Metabolic parameters add no value for OHCA neurological prognostication; leaves open utility in IHCA and requires prospective validation.
Background: In cardiac arrest survivors, metabolic parameters [pH value, lactate concentration, and base deficit (BD)] are routinely added to peri-arrest factors (including age, sex, bystander cardiopulmonary resuscitation, shockable first rhythm, resuscitation duration, adrenaline dose) to enhance early outcome prediction. However, the additional value of this strategy remains unclear. Methods: We used our resuscitation database to screen all patients ≥18 years who had suffered in- or out-of-hospital cardiac arrest (IHCA, OHCA) between January 1st, 2005 and May 1st, 2019. Patients with incomplete data, without return of spontaneous circulation or treatment with sodium bicarbonate were excluded. To analyse the added value of metabolic parameters to prognosticate neurological function, we built three models using logistic regression. These models included: (1) Peri-arrest factors only, (2) peri-arrest factors plus metabolic parameters and (3) metabolic parameters only. Receiver operating characteristics curves regarding 30-day good neurological function (Cerebral Performance Category 1-2) were analysed. Results: A total of 2,317 patients (OHCA: n = 1842) were included. In patients with OHCA, model 1 and 2 had comparable predictive value. Model 3 was inferior compared to model 1. In IHCA patients, model 2 performed best, whereas both metabolic (model 3) and peri-arrest factors (model 1) demonstrated similar power. PH, lactate and BD had interchangeable areas under the curve in both IHCA and OHCA. Conclusion: Although metabolic parameters may play a role in IHCA, no additional value in the prediction of good neurological outcome could be found in patients with OHCA. This highlights the importance of accurate anamnesis especially in patients with OHCA.
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Müeller et al. (2021) conducted an observational in Cardiac arrest (n=2,317). Metabolic parameters (blood pH, lactate, base deficit) vs. Peri-arrest factors alone was evaluated on Difference in performance (AUC) between model 1 (peri-arrest factors) and model 2 (peri-arrest factors plus metabolic parameters) in the prediction of good neurological outcome (CPC 1-2) at 30 days in OHCA (p=0.013). Adding metabolic parameters (pH, lactate, base deficit) to peri-arrest factors did not significantly improve the prediction of 30-day good neurological outcome after out-of-hospital cardiac arrest.
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