Veno-arterial CO2 difference and lactate for prediction of early mortality after cardiac arrest
Lundin, Andreas ; Annborn, Martin LU ; Borgquist, Ola LU ; Düring, Joachim LU
; Undén, Johan
LU
and Rylander, Christian
(2023)
In Acta Anaesthesiologica Scandinavica
67(5).
p.655-662
- Abstract
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 pCO2 difference (∆pCO2; 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 ∆pCO2 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... (More)
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 pCO2 difference (∆pCO2; 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 ∆pCO2 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 ∆pCO2 levels between 96-h survivors and non-survivors. ∆pCO2 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 ∆pCO2 and lactate, respectively. Our results do not support the use of ∆pCO2 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.
(Less)
- author
- Lundin, Andreas
; Annborn, Martin
LU
; Borgquist, Ola
LU
; Düring, Joachim
LU
; Undén, Johan
LU
and Rylander, Christian
- organization
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- cardiac arrest, postresuscitation care, prognosis, veno-arterial pCO gap
- in
- Acta Anaesthesiologica Scandinavica
- volume
- 67
- issue
- 5
- pages
- 8 pages
- publisher
- Wiley-Blackwell
- external identifiers
-
- scopus:85150812702
- pmid:36867177
- ISSN
- 0001-5172
- DOI
- 10.1111/aas.14224
- language
- English
- LU publication?
- yes
- id
- a96c12a3-0cba-4fb2-9d87-1fb00c79cca5
- date added to LUP
- 2023-05-26 14:28:53
- date last changed
- 2024-06-29 04:38:04
@article{a96c12a3-0cba-4fb2-9d87-1fb00c79cca5,
abstract = {{<p>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<sub>2</sub> difference (∆pCO<sub>2</sub>; central venous CO<sub>2</sub> – arterial CO<sub>2</sub>) 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 ∆pCO<sub>2</sub> 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 ∆pCO<sub>2</sub> levels between 96-h survivors and non-survivors. ∆pCO<sub>2</sub> 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 ∆pCO<sub>2</sub> and lactate, respectively. Our results do not support the use of ∆pCO<sub>2</sub> 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.</p>}},
author = {{Lundin, Andreas and Annborn, Martin and Borgquist, Ola and Düring, Joachim and Undén, Johan and Rylander, Christian}},
issn = {{0001-5172}},
keywords = {{cardiac arrest; postresuscitation care; prognosis; veno-arterial pCO gap}},
language = {{eng}},
number = {{5}},
pages = {{655--662}},
publisher = {{Wiley-Blackwell}},
series = {{Acta Anaesthesiologica Scandinavica}},
title = {{Veno-arterial CO<sub>2</sub> difference and lactate for prediction of early mortality after cardiac arrest}},
url = {{http://dx.doi.org/10.1111/aas.14224}},
doi = {{10.1111/aas.14224}},
volume = {{67}},
year = {{2023}},
}