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Observational Study
. 2017 Dec 21;21(1):322.
doi: 10.1186/s13054-017-1893-9.

Initial blood pH during cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients: a multicenter observational registry-based study

Jonghwan Shin  1 , Yong Su Lim  2 , Kyuseok Kim  3 , Hui Jai Lee  1 , Se Jong Lee  1 , Euigi Jung  1 , Kyoung Min You  1 , Hyuk Jun Yang  4 , Jin Joo Kim  4 , Joonghee Kim  3 , You Hwan Jo  3 , Jae Hyuk Lee  3 , Seong Youn Hwang  5
Affiliations
Observational Study

Initial blood pH during cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients: a multicenter observational registry-based study

Jonghwan Shin et al. Crit Care. .

Abstract

Background: When an out-of-hospital cardiac arrest (OHCA) patient receives cardiopulmonary resuscitation (CPR) in the emergency department (ED), blood laboratory test results can be obtained by using point-of-care testing during CPR. In the present study, the relationship between blood laboratory test results during CPR and outcomes of OHCA patients was investigated.

Methods: This study was a multicenter retrospective analysis of prospective registered data that included 2716 OHCA patients. Data from the EDs of three university hospitals in different areas were collected from January 2009 to December 2014. Univariate and multivariable analyses were conducted to elucidate the factors associated with survival to discharge and neurological outcomes. A final analysis was conducted by including patients who had no prehospital return of spontaneous circulation and those who underwent rapid blood laboratory examination during CPR.

Results: Overall, 2229 OHCA patients were included in the final analysis. Among them, the rate of survival to discharge and a good Cerebral Performance Categories Scale score were 14% and 4.4%, respectively. The pH level was independently related to survival to hospital discharge (adjusted OR 6.287, 95% CI 2.601-15.197; p < 0.001) and good neurological recovery (adjusted OR 15.395, 95% CI 3.439-68.911; p < 0.001). None of the neurologically intact patients had low pH levels (< 6.8) or excessive potassium levels (> 8.5 mEq/L) during CPR.

Conclusions: Among the blood laboratory test results during CPR of OHCA patients, pH and potassium levels were observed as independent factors associated with survival to hospital discharge, and pH level was considered as an independent factor related to neurological recovery.

Keywords: Cardiopulmonary resuscitation; Out-of-hospital cardiac arrest; pH.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the institutional review board of the Boramae Medical Center (20150709/16-2015-93/081), Bundang Seoul National University (B-1706/402-105), and Gil Medical Center (GCIRB 2016-365). Each hospital obtained approval from their respective institutional review board for data collection and follow-up of OHCA patients under the waiver of informed consent granted by the ethics committee.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study population and outcomes of out-of-hospital cardiac arrest (OHCA). ACLS Advanced cardiac life support, ROSC Return of spontaneous circulation, BGA Blood gas analysis
Fig. 2
Fig. 2
Outcomes according to the initial pH level, potassium level, and pH + K+ score during advanced cardiovascular life support. a pH. b Potassium. c pH + K+ score. Gray line = survival to hospital discharge, black line = good neurological recovery
Fig. 3
Fig. 3
ROC curves of pH score, potassium score, and pH + K+ score for good neurological recovery. a Total patients. b Patients with presumed cardiac origin. c Patients with presumed noncardiac origin
Fig. 4
Fig. 4
The change of call-to-hospital arrival time according to the pH score and pH + K+ score in witnessed out-of-hospital cardiac arrest patients
See this image and copyright information in PMC

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References

    1. Monsieurs KG, Nolan JP, Bossaert LL, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation. 2015;95:1–80. doi: 10.1016/j.resuscitation.2015.07.038. - DOI - PubMed
    1. Neumar RW, Shuster M, Callaway CW, et al. Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S315–67. doi: 10.1161/CIR.0000000000000252. - DOI - PubMed
    1. Shinozaki K, Oda S, Sadahiro T, Nakamura M, et al. Blood ammonia and lactate levels on hospital arrival as a predictive biomarker in patients with out-of-hospital cardiac arrest. Resuscitation. 2011;82:404–9. doi: 10.1016/j.resuscitation.2010.10.026. - DOI - PubMed
    1. Spindelboeck W, Schindler O, Moser A, et al. Increasing arterial oxygen partial pressure during cardiopulmonary resuscitation is associated with improved rates of hospital admission. Resuscitation. 2013;84:770–5. doi: 10.1016/j.resuscitation.2013.01.012. - DOI - PubMed
    1. Aschauer S, Dorffner G, Sterz F, et al. A prediction tool for initial out-of-hospital cardiac arrest survivors. Resuscitation. 2014;85:1225–31. doi: 10.1016/j.resuscitation.2014.06.007. - DOI - PubMed

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