Lactate Clearance and Outcomes After Cardiac Arrest Resuscitation

Authors: Lee DH et al., Resuscitation 2014 Nov 14;

A Korean database study showed slightly higher rates of survival to hospital discharge with lactate reductions within the first hour.

Rapid reductions in serum lactate levels have been associated with lower mortality in patients with sepsis and trauma, however, little is known about the effect in survivors of out-of-hospital cardiac arrest (OHCA) who have been treated with therapeutic hypothermia. Researchers analyzed data from 2007 to 2012 from the Korean Hypothermia Network registry for adults with return of spontaneous circulation (ROSC) in the field (14) or emergency department (429) after nontraumatic OHCA who underwent therapeutic hypothermia and had serum lactate measured within 1 hour after ROSC.

Of the 443 patients, 57% survived to hospital discharge, and 22% had favorable neurologic outcomes. Lactate levels measured within the first hour of resuscitation were significantly lower in survivors than nonsurvivors at hospital discharge (9.55 vs. 11.36 mmol/L).

Comment
This statistically significant difference in lactate levels between survivors and nonsurvivors is small and likely is of no clinical value. Shorter duration of arrest, more effective perfusion after return of spontaneous circulation, and more effective cardiopulmonary resuscitation, among other things, all will portend better prognosis and likely be reflected by lower total lactate levels. Lactate measurement in the postarrest period might be of future use, but is not helpful currently for predicting outcomes.