Clinical paperBlood ammonia and lactate levels on hospital arrival as a predictive biomarker in patients with out-of-hospital cardiac arrest☆
Section snippets
Study design
This is a multicentre, prospective, observational study conducted between May 2007 and March 2009 at three hospitals, all located in Chiba Prefecture, Japan. The subjects of the present study consisted of patients aged 18 years or older, who presented with non-traumatic OHCA and gained sustained return of spontaneous circulation (ROSC).
Patient characteristics were extracted from EMS reports and medical records of each receiving hospital. The term definition conformed to ‘glossary of terms’ as
Eligible and included patients
During the study period, a total of 912 non-traumatic eligible patients (535 men and 377 women; mean age, 71 ± 15 years; range, 18–102 years) were admitted to the three hospitals. Of these 912 patients, 157 patients (17%) exhibiting sustained ROSC were admitted to the acute care unit. Because biomarker levels could be measured during the daytime only (when the clinical laboratory of each institution was open), some samples were lost. Therefore, blood ammonia and lactate values within 15 min of
Prognostic factors
It has recently been reported that blood ammonia level measured on arrival is useful as a prognostic predictor for CA.13, 18 In this study, blood ammonia was compared with lactate, which has already been reported to be a valuable predictor.9 We determined the optimal cut-off value for each biomarker predictive of favourable neurological outcome and then performed multivariate logistic regression analysis with all variables, including these biomarkers and parameters from the Utstein templates2
Limitations
This study was potentially biased for some factors. First, in the present study, the decision to perform hypothermia therapy was left to each physician treating each included patient on a case-by-case basis, as we could not establish clear and definite criteria for the use of hypothermia. Therefore, it is impossible to adopt a study design involving therapeutic hypothermia therapy with clearly defined criteria for its use in the assessment of outcome in CA. We made every possible effort to
Conclusions
A blood ammonia level of less than 170 μg dl−1 and a lactate level of less than 12.0 mmol l−1 measured in a non-traumatic OHCA patient on arrival at hospital predicts its favourable neurological outcome in a patient with sustained ROSC.
We also underscore that combined ammonia and lactate become stronger predictors of ‘poor’ neurological outcome when both of them are over threshold, while when both of them are under threshold they could indicate an acceptable chance of favourable neurological
Conflicts of interest
No conflicts of interest to declare.
Acknowledgements
A part of this work was supported by Grant-in-Aid for Young Scientists (Category B 20791321) granted by the Ministry of Education, Culture, Sports, Science and Technology Japan.
References (26)
- et al.
Incidence of EMS-treated out-of-hospital cardiac arrest in the United States
Resuscitation
(2004) - et al.
Venous and arterial blood gases during and after cardiopulmonary resuscitation in dogs
Am J Emerg Med
(1985) - et al.
Lactic acidosis during closed-chest CPR in dogs
Ann Emerg Med
(1987) - et al.
Comparison of lactate or BE during out-of-hospital cardiac arrest to determine metabolic acidosis
Resuscitation
(2001) - et al.
Effective lactate clearance is associated with improved outcome in post-cardiac arrest patients
Resuscitation
(2007) - et al.
Relationship between laboratory findings and the outcome of cardiopulmonary arrest
Am J Emerg Med
(2009) - et al.
Resting peripheral blood lactate elevation in survivors of prehospital cardiac arrest: correlation with hemodynamic, electrophysiologic and oxyhemoglobin dissociation indexes
Am J Cardiol
(1979) - et al.
Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council
Circulation
(1991) - et al.
Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa)
Circulation
(2004) - et al.
The ACLS score. Predicting survival from out-of-hospital cardiac arrest
JAMA
(1981)
Predicting the outcome of unsuccessful prehospital advanced cardiac life support
JAMA
Racial differences in the incidence of cardiac arrest and subsequent survival. The CPR Chicago Project
N Engl J Med
The association between blood lactate concentration on admission, duration of cardiac arrest, and functional neurological recovery in patients resuscitated from ventricular fibrillation
Intensive Care Med
Cited by (80)
The association between blood glucose levels on arrival at the hospital and patient outcomes after out-of-hospital cardiac arrest: A multicenter cohort study
2024, American Journal of Emergency MedicinePCO<inf>2</inf> on arrival as a predictive biomarker in patients with out-of-hospital cardiac arrest
2023, American Journal of Emergency Medicine
- ☆
A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2010.10.026.