Predictive accuracy of biomarkers for survival among cardiac arrest patients with hypothermia: a prospective observational cohort study in Japan

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Tetsuro Nishimura¹  Tasuku Matsuyama²  Kazuo Noguchi³  Koichi Hayakawa⁴  Fumiko Nakamura⁵  Takuya Ishibe⁶  Haruko Sakamoto⁷  Takashi Kawamura⁸  Taku Iwami⁸  Norihiro Nishioka⁸  Yohei Okada⁸  Kaoru Koike⁹  Taro Irisawa^1,10  Takeshi Shimazu^1,10  Kazuhisa Yoshiya^1,10  Tetsuhisa Kitamura^1,11  Satoshi Matsui^1,11  Keitaro Suzuki^1,12  Takaya Morooka^1,13  Tomoki Yamada^1,14  Takeyuki Kiguchi^1,15  Yoshiki Yagi^1,16  Masafumi Kishimoto^1,17  Yasuyuki Hayashi^1,18  Hiroshi Shintani^1,19  Taku Sogabe^2,20 

[1] Department of Critical Care Medicine, Osaka City University;Department of Emergency Medicine, Kyoto Prefectural University of Medicine;Department of Emergency Medicine, Tane General Hospital;Department of Emergency and Critical Care Medicine, Kansai Medical University, Takii Hospital;Department of Emergency and Critical Care Medicine, Kansai Medical University;Department of Emergency and Critical Care Medicine, Kinki University School of Medicine;Department of Pediatrics, Osaka Red Cross Hospital;Department of Preventive Services, School of Public Health;Department of Primary care and Emergency Medicine, Graduate School of Medicine, Kyoto University;Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine;Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University;Emergency and Critical Care Medical Center, Kishiwada Tokushukai Hospital;Emergency and Critical Care Medical Center, Osaka City General Hospital;Emergency and Critical Care Medical Center, Osaka Police Hospital;Kyoto University Health Services;Osaka Mishima Emergency Critical Care Center;Osaka Prefectural Nakakawachi Medical Center of Acute Medicine;Senri Critical Care Medical Center, Saiseikai Senri Hospital;Senshu Trauma and Critical Care Center;Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital;

关键词: Out-of-hospital cardiac arrest;    Hypothermia;    Diagnosis;    Prediction;    Prognosis;   

DOI  :  10.1186/s13049-020-00765-2

来源: DOAJ

【 摘 要 】

Abstract Background There is limited information on the predictive accuracy of commonly used predictors, such as lactate, pH or serum potassium for the survival among out-of-hospital cardiac arrest (OHCA) patients with hypothermia. This study aimed to identify the predictive accuracy of these biomarkers for survival among OHCA patients with hypothermia. Methods In this retrospective analysis, we analyzed the data from a multicenter, prospective nationwide registry among OHCA patients transported to emergency departments in Japan (the JAAM-OHCA Registry). We included all adult (≥18 years) OHCA patients with hypothermia (≤32.0 °C) who were registered from June 2014 to December 2017 and whose blood test results on hospital arrival were recorded. We calculated the predictive accuracy of pH, lactate, and potassium for 1-month survival. Results Of the 34,754 patients in the JAAM-OHCA database, we included 754 patients from 66 hospitals. The 1-month survival was 5.8% (44/754). The areas under the curve of the predictors and 95% confidence interval were as follows: pH 0.829 [0.767–0.877] and lactate 0.843 [0.793–0.882]. On setting the cutoff points of 6.9 in pH and 120 mg/dL (13.3 mmol/L) in lactate, the predictors had a high sensitivity (lactate: 0.91; pH 0.91) and a low negative likelihood ratio (lactate: 0.14; pH 0.13), which are suitable to exclude survival to 1 month. Furthermore, in additional analysis that included only the patients with potassium values available, a cutoff point of 7.0 (mmol/L) for serum potassium had high sensitivity (0.96) and a low negative likelihood ratio (0.09). Conclusion This study indicated the predictive accuracy of serum lactate, pH, and potassium for 1-month survival among adult OHCA patients with hypothermia. These biomarkers may help define a more appropriate resuscitation strategy.

【 授权许可】

Unknown