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

摘要

Abstract BackgroundThe 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.MethodsThis 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.ResultOf 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.ConclusionsIn 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.