Anesthesia Management: Lactate Levels May Predict Prognosis in Comatose Post-Cardiac Arrest Patients

Authors: Donnino MW et al., Crit Care Med 2014 Apr 25;

Lower lactate levels and more rapid lactate clearance were associated with improved survival and good neurologic outcomes.

Although guidelines recommend serial lactate measurements to assess perfusion in critically ill patients, data to support this approach are derived mainly from burn, trauma, and septic patients and not from post-cardiac arrest populations. Using data from a four-hospital cardiac arrest research consortium, investigators studied the association between lactate changes and outcomes in 100 adults with out-of-hospital cardiac arrest who remained comatose after return of spontaneous circulation. Forty-six patients survived to hospital discharge, of whom 30 had good neurologic outcomes.

Median Lactate Levels (mmol/L)

Median lactate levels at 0, 12, and 24 hours were significantly lower in survivors than in nonsurvivors and in patients with good neurologic outcomes than in those with poor neurologic outcomes (see table). The percent lactate reduction at 12 hours was 44% in both survivors and patients with good neurologic outcomes, compared with 32% in both nonsurvivors and patients with poor neurologic outcomes.

Comment

This statistical association is just one piece in understanding how lactate levels relate to patient outcomes in comatose post-cardiac arrest patients. Lactate level is a marker of metabolic dysfunction and might help clinicians assess the effectiveness of various post-resuscitation management strategies.