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Cardiac arrest—Emergency department evaluation—The first minute
Poster Presentations / Resuscitation 84S (2013) S8–S98
AP199 Biomarkers and survival outcomes in patients undergoing therapeutic hypothermia after cardiac arrest. Is serum lactate useful? ˜ ∗ , Jaume Fontanals Marta Magaldi Mendana Dotras, Montserrat Fontanals Caravaca, Jacobo Moreno Garijo Hospital Clinic y Provincial, Barcelona, Spain Purpose of study: Therapeutic hypothermia (TH) has been demonstrated to improve both survival and neurological outcomes after cardiac arrest (CA). Recent studies have suggested that serum lactate may serve as a marker to predict mortality after resuscitation from CA. The aim of our study is to assess if serum lactate values are associated with survival to discharge. Materials and methods: Prospectively collected serum lactate values in patients resuscitated from CA and treated with TH. They were cooled by placing an adhesive plate of energy transfer and a module for temperature control. Patients reached 33 ◦ C in less than 8 h from CA and it was maintained for 24 h. Warming took place gradually in 24–30 h. Serum lactate levels were measured initially after recovery of spontaneous circulation, and subsequently every 6 h during the first 48 h. Our primary endpoint was defined as inhospital mortality. Data analysis was performed by using statistical software package (SPSS v.18). Results: 80 patients were included, 62 male and 18 female (77.5%M/22.5%F), with a mean age of 55.87 ± 15.84 years. 67(83.5%) patients experienced out-of-hospital CA and 13(16.25%) had an inhospital CA. Initial arrest rhythms were classified into shockable (87.5%) and non-shockable (12.5%) rhythms. Mean lactate for survivors at 1, 6, 12 and 18 h was lower compared to the values in non-survivors (p < 0.05). Non-statistically significant difference after 24 h on mortality was found in our study (Table 1). High serum lactate levels in the first 24 h after recovery of spontaneous circulation after CA are associated with an increase of mortality in patients undergoing TH. Table 1 Comparison in lactate values between survivors and non-survivors. 1h
6h
12 h
18 h
24 h
Survivors (n = 53)*
2.98 ± 1.85
2.99 ± 1.75
2.75 ± 1.87
2.27 ± 1.45
2.15 ± 1.40
Non- survivors (n = 27)* p**
5.91 ± 7.34
4.65 ± 5.44
5.22 ± 6.86
4.56 ± 5.29
3.4 ± 4.64
0.011
0.05
0.021
0.005
0.095
* **
Data expressed in (mmol/L) mean ± standard deviation. Data expressed in number.
Conclusions: Our results are according to other studies conducted and confirm that tissue hypoperfusion in these kind of patients is reflected in changes in serum lactate. Further studies should be conducted to find biomarkers that help us improving the ability to prognosticate outcomes. http://dx.doi.org/10.1016/j.resuscitation.2013.08.225 AP200 Cardiac arrest—Emergency department evaluation—The first minute Diana Carmen Cimpoesu ∗ , Amir Zabida, Antoniu Petris University of Medicine and Pharmacy Gr.T. Popa, Iasi, Romania Background: A variety of ancillary tests can help diagnose potentially reversible causes of cardiac arrest. It is proved that the
S89
patient in full arrest derives little benefit from laboratory tests that require the traditional 30 min to process. However, certain pointof-care tests may be of some value. Purpose of the study: To analyse the evolution of the patients with cardiac arrest and the prognosis in relation with history, physical examination and laboratory tests. Materials and methods: We considered the patients with cardiac arrest in the Emergency Department (ED) of the University Hospital, Iasi, Romania, between the 1st of January to the 31st of May 2013, and we analysed all the available data, including laboratory tests during resuscitation. Results: The study included 50 patients, having the average age of 69.76 ± 12.48 years, predominantly male (66%), with cardiac arrest (76% OHCA, 24% in ED), receiving ALS for: 14% cases with VF/VTah, 28% PEA and 58% Asystole. Labs showed hipoK in 10% and hiperK in 20%, high blood glucose in 54% cases, over normal lactic acid in 56% cases. We documented increase of NT-proBNP in 24% of the cases, TnI in 46% cases, CK-MB in a quarter of the cases. ROSC was obtained at 21 patients but the survival rate at 24 h was 36%, 69,4% patients hemodynamic unstable after ROSC, needing positive inotrop support. Mortality was correlated with resuscitation duration (p < 0.001) and epinephrine doses (p < 0.001). Conclusion: Following the ERC guidelines, the survival rate was a considerable one. Looking to the laboratory tests in ED during resuscitation maneuvers, allowed us to find and solve the reversible causes of the cardiac arrest and improve the outcomes. http://dx.doi.org/10.1016/j.resuscitation.2013.08.226 AP201 Long-term effects of mild therapeutic hypothermia in out-of-hospital cardiac arrest survivors: A retrospective observational study Yuchan Kye ∗ , Jonghwan Shin, Huijai Lee Seoul National University Boramae Medical Center, Seoul, Republic of Korea Objectives: Only mild therapeutic hypothermia (TH) has been approved to improve outcomes of out-of-hospital cardiac arrest (OHCA) survivors. However, studies examining long term functional status in OHCA survivors after hospital discharge are scarce. We aimed to assess whether TH has a long-term effect on outcomes of OHCA survivors. Methods: In a retrospective, single-center, observational study, conducted between April 1, 2013 and April 30, 2013, we investigated the electronic medical record database for OHCA survivors to evaluate functional status at hospital discharge using the cerebral performance category (CPC) from March 2009 to December 2012. Subsequently, telephone interviews were conducted to assess long term outcome on the basis of CPC scores. Age, gender, witnessed arrest, initial shockable rhythm, bystander cardiopulmonary resuscitation and field return of spontaneous circulation were considered variables that might influence outcome and were statistically analyzed using the multivariable logistic regression. Results: During the study period, 56 patients were discharged alive, of whom 16 received TH, and, 40 did not. The median follow-up period after hospital discharge was 18.6 months. Upon discharge, good neurologic outcome (CPC 1-2) was reported in 4 of the 16 patients who received TH and 4 of the 40 patients who did not receive TH. During the follow-up period, 4 patients who received TH and 1 patient who did not receive TH exhibited improved CPC scores. After multivariable logistic regression, TH is the only statistically significant variable of long-term CPC improvement in survival discharge patients after cardiac arrest (p = 0.028).
AP199 Biomarkers and survival outcomes in patients undergoing therapeutic hypothermia after cardiac arrest. Is serum lactate useful? ˜ ∗ , Jaume Fontanals Marta Magaldi Mendana Dotras, Montserrat Fontanals Caravaca, Jacobo Moreno Garijo Hospital Clinic y Provincial, Barcelona, Spain Purpose of study: Therapeutic hypothermia (TH) has been demonstrated to improve both survival and neurological outcomes after cardiac arrest (CA). Recent studies have suggested that serum lactate may serve as a marker to predict mortality after resuscitation from CA. The aim of our study is to assess if serum lactate values are associated with survival to discharge. Materials and methods: Prospectively collected serum lactate values in patients resuscitated from CA and treated with TH. They were cooled by placing an adhesive plate of energy transfer and a module for temperature control. Patients reached 33 ◦ C in less than 8 h from CA and it was maintained for 24 h. Warming took place gradually in 24–30 h. Serum lactate levels were measured initially after recovery of spontaneous circulation, and subsequently every 6 h during the first 48 h. Our primary endpoint was defined as inhospital mortality. Data analysis was performed by using statistical software package (SPSS v.18). Results: 80 patients were included, 62 male and 18 female (77.5%M/22.5%F), with a mean age of 55.87 ± 15.84 years. 67(83.5%) patients experienced out-of-hospital CA and 13(16.25%) had an inhospital CA. Initial arrest rhythms were classified into shockable (87.5%) and non-shockable (12.5%) rhythms. Mean lactate for survivors at 1, 6, 12 and 18 h was lower compared to the values in non-survivors (p < 0.05). Non-statistically significant difference after 24 h on mortality was found in our study (Table 1). High serum lactate levels in the first 24 h after recovery of spontaneous circulation after CA are associated with an increase of mortality in patients undergoing TH. Table 1 Comparison in lactate values between survivors and non-survivors. 1h
6h
12 h
18 h
24 h
Survivors (n = 53)*
2.98 ± 1.85
2.99 ± 1.75
2.75 ± 1.87
2.27 ± 1.45
2.15 ± 1.40
Non- survivors (n = 27)* p**
5.91 ± 7.34
4.65 ± 5.44
5.22 ± 6.86
4.56 ± 5.29
3.4 ± 4.64
0.011
0.05
0.021
0.005
0.095
* **
Data expressed in (mmol/L) mean ± standard deviation. Data expressed in number.
Conclusions: Our results are according to other studies conducted and confirm that tissue hypoperfusion in these kind of patients is reflected in changes in serum lactate. Further studies should be conducted to find biomarkers that help us improving the ability to prognosticate outcomes. http://dx.doi.org/10.1016/j.resuscitation.2013.08.225 AP200 Cardiac arrest—Emergency department evaluation—The first minute Diana Carmen Cimpoesu ∗ , Amir Zabida, Antoniu Petris University of Medicine and Pharmacy Gr.T. Popa, Iasi, Romania Background: A variety of ancillary tests can help diagnose potentially reversible causes of cardiac arrest. It is proved that the
S89
patient in full arrest derives little benefit from laboratory tests that require the traditional 30 min to process. However, certain pointof-care tests may be of some value. Purpose of the study: To analyse the evolution of the patients with cardiac arrest and the prognosis in relation with history, physical examination and laboratory tests. Materials and methods: We considered the patients with cardiac arrest in the Emergency Department (ED) of the University Hospital, Iasi, Romania, between the 1st of January to the 31st of May 2013, and we analysed all the available data, including laboratory tests during resuscitation. Results: The study included 50 patients, having the average age of 69.76 ± 12.48 years, predominantly male (66%), with cardiac arrest (76% OHCA, 24% in ED), receiving ALS for: 14% cases with VF/VTah, 28% PEA and 58% Asystole. Labs showed hipoK in 10% and hiperK in 20%, high blood glucose in 54% cases, over normal lactic acid in 56% cases. We documented increase of NT-proBNP in 24% of the cases, TnI in 46% cases, CK-MB in a quarter of the cases. ROSC was obtained at 21 patients but the survival rate at 24 h was 36%, 69,4% patients hemodynamic unstable after ROSC, needing positive inotrop support. Mortality was correlated with resuscitation duration (p < 0.001) and epinephrine doses (p < 0.001). Conclusion: Following the ERC guidelines, the survival rate was a considerable one. Looking to the laboratory tests in ED during resuscitation maneuvers, allowed us to find and solve the reversible causes of the cardiac arrest and improve the outcomes. http://dx.doi.org/10.1016/j.resuscitation.2013.08.226 AP201 Long-term effects of mild therapeutic hypothermia in out-of-hospital cardiac arrest survivors: A retrospective observational study Yuchan Kye ∗ , Jonghwan Shin, Huijai Lee Seoul National University Boramae Medical Center, Seoul, Republic of Korea Objectives: Only mild therapeutic hypothermia (TH) has been approved to improve outcomes of out-of-hospital cardiac arrest (OHCA) survivors. However, studies examining long term functional status in OHCA survivors after hospital discharge are scarce. We aimed to assess whether TH has a long-term effect on outcomes of OHCA survivors. Methods: In a retrospective, single-center, observational study, conducted between April 1, 2013 and April 30, 2013, we investigated the electronic medical record database for OHCA survivors to evaluate functional status at hospital discharge using the cerebral performance category (CPC) from March 2009 to December 2012. Subsequently, telephone interviews were conducted to assess long term outcome on the basis of CPC scores. Age, gender, witnessed arrest, initial shockable rhythm, bystander cardiopulmonary resuscitation and field return of spontaneous circulation were considered variables that might influence outcome and were statistically analyzed using the multivariable logistic regression. Results: During the study period, 56 patients were discharged alive, of whom 16 received TH, and, 40 did not. The median follow-up period after hospital discharge was 18.6 months. Upon discharge, good neurologic outcome (CPC 1-2) was reported in 4 of the 16 patients who received TH and 4 of the 40 patients who did not receive TH. During the follow-up period, 4 patients who received TH and 1 patient who did not receive TH exhibited improved CPC scores. After multivariable logistic regression, TH is the only statistically significant variable of long-term CPC improvement in survival discharge patients after cardiac arrest (p = 0.028).