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Clearance of delta neutrophil index and lactate as a predictive marker in post-cardiac arrest
Abstracts / Resuscitation 106S (2016) e23–e95
Fig. 1.
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Materials and methods: This is a prospective observational study. Non-traumatic, adult cardiac arrest patients who survived for at least 24 h after return of spontaneous circulation (ROSC) and admitted to emergency intensive unit were included. Blood lactate and DNI levels were measured at T0 (immediately on ROSC) and T24 h (24 h after admission). We compared the initial levels and differences in the percent fraction of lactate and DNI over 24 h. The primary outcome was survival at hospital discharge, and secondary outcome was favourable neurological outcome. Results: Of the 166 patients, 27 (16.3%) had an initial shockable rhythms. The overall rates for survival and favourable neurologic outcomes were 17.3% and 13.1%, respectively. In the shockable rhythm group, survivors and patients with good neurologic outcome had lower initial lactate level (p = 0.027), but not initial DNI (p = 0.409), lactate clearance (p = 0.338) and DNI clearance (p = 0.176). In the non-shockable rhythm group, favourable survival outcomes had higher DNI clearance (p = 0.007) and lactate clearance (p = 0.017), but not initial DNI (p = 0.783) and lactate (p = 0.425). Conclusions: Higher DNI and lactate clearances are available parameters for 30-day survival outcomes after cardiac arrest with non-shockable rhythms. These findings suggest that early, effective goal therapy of both shock and SIRS plays an important role in postcardiac arrest patients. http://dx.doi.org/10.1016/j.resuscitation.2016.07.206 AP159 Public location and male gender, but not the duration of resuscitation attempt, predict cardiopulmonary resuscitation related injuries in out-of-hospital cardiac arrest Piritta Setälä 1,∗ , Heidi Hellevuo 2 , Riikka Nevalainen 3 , Antti Kämäräinen 1 , Ilkka Virkkunen 4 , Arvi Yli-Hankala 5 , Heini Huhtala 6 , Sanna Hoppu 7 1
Fig. 2.
Conclusion: We conclude that a nomogram could be an interesting visualization tool for physicians, and it shows that providing airway devices during transportation to ED might be discouraged. http://dx.doi.org/10.1016/j.resuscitation.2016.07.205 AP158 Clearance of delta neutrophil index and lactate as a predictive marker in post-cardiac arrest Hyun Il Seo ∗ , Kang Suk Seo, Mi Jin Lee, Changwon Park, Hae Won Jung, Jang Soo Seo Kyungpook National University Hospital, Daegu, Republic of Korea Purpose: The post-cardiac arrest syndrome is associated with shock and systemic inflammatory response syndrome (SIRS). We speculate that lactate clearance (for hypo-perfusion indicator) and the delta neutrophil index (DNI) clearance (as the immature leukocyte sub-fractions for SIRS) may predict outcomes in post-cardiac arrest patients.
Emergency Medical Service, Tampere University Hospital, Tampere, Finland 2 Medical School, University of Tampere, Tampere, Finland 3 Medical Imaging Centre, Tampere University Hospital, Tampere, Finland 4 FinnHEMS Research and Development Unit, FinnHEMS Ltd, Vantaa, Finland 5 Medical School, University of Tampere and Department of Anaesthesia, Tampere University Hospital, Tampere, Finland 6 School of Health Sciences, University of Tampere, Tampere, Finland 7 Department of Intensive Care, Tampere University Hospital, Tampere, Finland Purpose of the study: New guidelines emphasize the provision of high-quality cardiopulmonary resuscitation (CPR).1 Although CPR-related injuries in out-of-hospital cardiac arrest (OHCA) are considered unavoidable, they affect the performance and attitudes of emergency medical service (EMS) personnel towards compliance with CPR guidelines.2–4 We determined the frequency and severity of CPR-related injuries in OHCA and examined patient and event characteristics in an EMS system where patients are not routinely transported to hospital with ongoing CPR but, instead, where CPR was performed on the scene. Material and methods: This observational study was conducted between 1.6.2013–31.5.2014 in Pirkanmaa, Finland. Data were col-
Fig. 1.
e85
Materials and methods: This is a prospective observational study. Non-traumatic, adult cardiac arrest patients who survived for at least 24 h after return of spontaneous circulation (ROSC) and admitted to emergency intensive unit were included. Blood lactate and DNI levels were measured at T0 (immediately on ROSC) and T24 h (24 h after admission). We compared the initial levels and differences in the percent fraction of lactate and DNI over 24 h. The primary outcome was survival at hospital discharge, and secondary outcome was favourable neurological outcome. Results: Of the 166 patients, 27 (16.3%) had an initial shockable rhythms. The overall rates for survival and favourable neurologic outcomes were 17.3% and 13.1%, respectively. In the shockable rhythm group, survivors and patients with good neurologic outcome had lower initial lactate level (p = 0.027), but not initial DNI (p = 0.409), lactate clearance (p = 0.338) and DNI clearance (p = 0.176). In the non-shockable rhythm group, favourable survival outcomes had higher DNI clearance (p = 0.007) and lactate clearance (p = 0.017), but not initial DNI (p = 0.783) and lactate (p = 0.425). Conclusions: Higher DNI and lactate clearances are available parameters for 30-day survival outcomes after cardiac arrest with non-shockable rhythms. These findings suggest that early, effective goal therapy of both shock and SIRS plays an important role in postcardiac arrest patients. http://dx.doi.org/10.1016/j.resuscitation.2016.07.206 AP159 Public location and male gender, but not the duration of resuscitation attempt, predict cardiopulmonary resuscitation related injuries in out-of-hospital cardiac arrest Piritta Setälä 1,∗ , Heidi Hellevuo 2 , Riikka Nevalainen 3 , Antti Kämäräinen 1 , Ilkka Virkkunen 4 , Arvi Yli-Hankala 5 , Heini Huhtala 6 , Sanna Hoppu 7 1
Fig. 2.
Conclusion: We conclude that a nomogram could be an interesting visualization tool for physicians, and it shows that providing airway devices during transportation to ED might be discouraged. http://dx.doi.org/10.1016/j.resuscitation.2016.07.205 AP158 Clearance of delta neutrophil index and lactate as a predictive marker in post-cardiac arrest Hyun Il Seo ∗ , Kang Suk Seo, Mi Jin Lee, Changwon Park, Hae Won Jung, Jang Soo Seo Kyungpook National University Hospital, Daegu, Republic of Korea Purpose: The post-cardiac arrest syndrome is associated with shock and systemic inflammatory response syndrome (SIRS). We speculate that lactate clearance (for hypo-perfusion indicator) and the delta neutrophil index (DNI) clearance (as the immature leukocyte sub-fractions for SIRS) may predict outcomes in post-cardiac arrest patients.
Emergency Medical Service, Tampere University Hospital, Tampere, Finland 2 Medical School, University of Tampere, Tampere, Finland 3 Medical Imaging Centre, Tampere University Hospital, Tampere, Finland 4 FinnHEMS Research and Development Unit, FinnHEMS Ltd, Vantaa, Finland 5 Medical School, University of Tampere and Department of Anaesthesia, Tampere University Hospital, Tampere, Finland 6 School of Health Sciences, University of Tampere, Tampere, Finland 7 Department of Intensive Care, Tampere University Hospital, Tampere, Finland Purpose of the study: New guidelines emphasize the provision of high-quality cardiopulmonary resuscitation (CPR).1 Although CPR-related injuries in out-of-hospital cardiac arrest (OHCA) are considered unavoidable, they affect the performance and attitudes of emergency medical service (EMS) personnel towards compliance with CPR guidelines.2–4 We determined the frequency and severity of CPR-related injuries in OHCA and examined patient and event characteristics in an EMS system where patients are not routinely transported to hospital with ongoing CPR but, instead, where CPR was performed on the scene. Material and methods: This observational study was conducted between 1.6.2013–31.5.2014 in Pirkanmaa, Finland. Data were col-