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Targeted temperature management guided by the severity of hyperlactatemia for out-of-hospital cardiac arrest patients: a post hoc analysis of a nationwide, multicenter prospective registry

BACKGROUND: The International Liaison Committee on Resuscitation guidelines recommend target temperature management (TTM) between 32 and 36 °C for patients after out-of-hospital cardiac arrest, but did not indicate patient-specific temperatures. The association of serum lactate concentration and neu...

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Autores principales: Okazaki, Tomoya, Hifumi, Toru, Kawakita, Kenya, Kuroda, Yasuhiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6864017/
https://www.ncbi.nlm.nih.gov/pubmed/31745738
http://dx.doi.org/10.1186/s13613-019-0603-y
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author Okazaki, Tomoya
Hifumi, Toru
Kawakita, Kenya
Kuroda, Yasuhiro
author_facet Okazaki, Tomoya
Hifumi, Toru
Kawakita, Kenya
Kuroda, Yasuhiro
author_sort Okazaki, Tomoya
collection PubMed
description BACKGROUND: The International Liaison Committee on Resuscitation guidelines recommend target temperature management (TTM) between 32 and 36 °C for patients after out-of-hospital cardiac arrest, but did not indicate patient-specific temperatures. The association of serum lactate concentration and neurological outcome in out-of-hospital cardiac arrest patient has been reported. The study aim was to investigate the benefit of 32–34 °C in patients with various degrees of hyperlactatemia compared to 35–36 °C. METHODS: This study was a post hoc analysis of the Japanese Association for Acute Medicine out-of-hospital cardiac arrest registry between June 2014 and December 2015. Patients with complete targeted temperature management and lactate data were eligible. Patients were stratified to mild (< 7 mmol/l), moderate (< 12 mmol/l), or severe (≥ 12 mmol/l) hyperlactatemia group based on lactate concentration after return of spontaneous circulation. They were subdivided into 32–34 °C or 35–36 °C groups. The primary endpoint was an adjusted predicted probability of 30-day favorable neurological outcome, defined as a cerebral performance category score of 1 or 2. RESULT: Of 435 patients, 139 had mild, 182 had moderate, and 114 had severe hyperlactatemia. One hundred and eight (78%) with mild, 128 with moderate (70%), and 83 with severe hyperlactatemia (73%) received TTM at 32–34 °C. The adjusted predicted probability of a 30-day favorable neurological outcome following severe hyperlactatemia was significantly greater with 32–34 °C (27.4%, 95% confidence interval: 22.0–32.8%) than 35–36 °C (12.4%, 95% CI 3.5–21.2%; p = 0.005). The differences in outcomes in those with mild and moderate hyperlactatemia were not significant. CONCLUSIONS: In OHCA patients with severe hyperlactatemia, the adjusted predicted probability of 30-day favorable neurological outcome was greater with TTM at 32–34 °C than with TTM at 35–36 °C. Further evaluation is needed to determine whether TTM at 32–34 °C can improve neurological outcomes in patients with severe hyperlactatemia after out-of-hospital cardiac arrest.
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spelling pubmed-68640172019-12-05 Targeted temperature management guided by the severity of hyperlactatemia for out-of-hospital cardiac arrest patients: a post hoc analysis of a nationwide, multicenter prospective registry Okazaki, Tomoya Hifumi, Toru Kawakita, Kenya Kuroda, Yasuhiro Ann Intensive Care Research BACKGROUND: The International Liaison Committee on Resuscitation guidelines recommend target temperature management (TTM) between 32 and 36 °C for patients after out-of-hospital cardiac arrest, but did not indicate patient-specific temperatures. The association of serum lactate concentration and neurological outcome in out-of-hospital cardiac arrest patient has been reported. The study aim was to investigate the benefit of 32–34 °C in patients with various degrees of hyperlactatemia compared to 35–36 °C. METHODS: This study was a post hoc analysis of the Japanese Association for Acute Medicine out-of-hospital cardiac arrest registry between June 2014 and December 2015. Patients with complete targeted temperature management and lactate data were eligible. Patients were stratified to mild (< 7 mmol/l), moderate (< 12 mmol/l), or severe (≥ 12 mmol/l) hyperlactatemia group based on lactate concentration after return of spontaneous circulation. They were subdivided into 32–34 °C or 35–36 °C groups. The primary endpoint was an adjusted predicted probability of 30-day favorable neurological outcome, defined as a cerebral performance category score of 1 or 2. RESULT: Of 435 patients, 139 had mild, 182 had moderate, and 114 had severe hyperlactatemia. One hundred and eight (78%) with mild, 128 with moderate (70%), and 83 with severe hyperlactatemia (73%) received TTM at 32–34 °C. The adjusted predicted probability of a 30-day favorable neurological outcome following severe hyperlactatemia was significantly greater with 32–34 °C (27.4%, 95% confidence interval: 22.0–32.8%) than 35–36 °C (12.4%, 95% CI 3.5–21.2%; p = 0.005). The differences in outcomes in those with mild and moderate hyperlactatemia were not significant. CONCLUSIONS: In OHCA patients with severe hyperlactatemia, the adjusted predicted probability of 30-day favorable neurological outcome was greater with TTM at 32–34 °C than with TTM at 35–36 °C. Further evaluation is needed to determine whether TTM at 32–34 °C can improve neurological outcomes in patients with severe hyperlactatemia after out-of-hospital cardiac arrest. Springer International Publishing 2019-11-19 /pmc/articles/PMC6864017/ /pubmed/31745738 http://dx.doi.org/10.1186/s13613-019-0603-y Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Research
Okazaki, Tomoya
Hifumi, Toru
Kawakita, Kenya
Kuroda, Yasuhiro
Targeted temperature management guided by the severity of hyperlactatemia for out-of-hospital cardiac arrest patients: a post hoc analysis of a nationwide, multicenter prospective registry
title Targeted temperature management guided by the severity of hyperlactatemia for out-of-hospital cardiac arrest patients: a post hoc analysis of a nationwide, multicenter prospective registry
title_full Targeted temperature management guided by the severity of hyperlactatemia for out-of-hospital cardiac arrest patients: a post hoc analysis of a nationwide, multicenter prospective registry
title_fullStr Targeted temperature management guided by the severity of hyperlactatemia for out-of-hospital cardiac arrest patients: a post hoc analysis of a nationwide, multicenter prospective registry
title_full_unstemmed Targeted temperature management guided by the severity of hyperlactatemia for out-of-hospital cardiac arrest patients: a post hoc analysis of a nationwide, multicenter prospective registry
title_short Targeted temperature management guided by the severity of hyperlactatemia for out-of-hospital cardiac arrest patients: a post hoc analysis of a nationwide, multicenter prospective registry
title_sort targeted temperature management guided by the severity of hyperlactatemia for out-of-hospital cardiac arrest patients: a post hoc analysis of a nationwide, multicenter prospective registry
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6864017/
https://www.ncbi.nlm.nih.gov/pubmed/31745738
http://dx.doi.org/10.1186/s13613-019-0603-y
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