Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr-Jun;16(2):48-53.
doi: 10.4103/jets.jets_138_22. Epub 2023 May 22.

Emergency Department Point-of-Care Tests during Cardiopulmonary Resuscitation to Predict Cardiac Arrest Outcomes

Ghanashyam Timilsina  1 , Ankit Kumar Sahu  1 , Nayer Jamshed  1 , Satish Kumar Singh  1 , Praveen Aggarwal  1
Affiliations

Emergency Department Point-of-Care Tests during Cardiopulmonary Resuscitation to Predict Cardiac Arrest Outcomes

Ghanashyam Timilsina et al. J Emerg Trauma Shock. 2023 Apr-Jun.

Abstract

Introduction: This study evaluated the role of point-of-care tests (POCT) such as blood lactate, anion gap (AG), base deficit, pH, N-terminal pro B-type natriuretic peptide (NT-proBNP), and troponin as the predictors of cardiac arrest outcomes in the emergency department (ED).

Methods: We conducted a prospective, observational study in the ED of a tertiary care hospital in India. All the adult patients who received cardiopulmonary resuscitation (CPR) in the ED were included in the study. Blood samples were collected within 10 min of initiation of CPR for assay of POCTs. Outcomes assessed were the return of spontaneous circulation (ROSC), 24-h survival, survival to hospital discharge (STHD), survival at 7 days, and favorable neurological outcome (FNO) at day 7 of admission.

Results: One hundred and fifty-one patients were included in the study (median age: 50 years, 65% males). Out of 151 cases, ROSC, survival at 7 days, STHD, and FNO was observed in 86 patients, six patients, five patients, and two patients, respectively. "No-ROSC" could be significantly predicted by raised lactate (odds ratio [OR]: 1.14, 95% confidence interval: 1.07-1.22) and NT-proBNP (OR: 1.05, 1.01-1.09) values at the time of cardiac arrest. "24-h mortality" could be significantly predicted by the raised lactate (OR: 1.14, 1.01-1.28), low arterial pH (OR: 0.05, 0.01-0.52), raised AG (OR: 1.08, 1.01-1.15), and lower base deficit (<-15) (OR: 1.07, 1.01-1.14). None of the other POCTs was found to be a predictor of other cardiac arrest outcomes.

Conclusion: Among various POCTs, raised lactate assayed within 10 min of cardiac arrest can predict poor outcomes like "no-ROSC" and 24-h mortality.

Keywords: Cardiac arrest; cardiopulmonary resuscitation; point of care tests.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
ROC curve of various point-of-care test for prediction of “no-ROSC”. Blood pH was not shown in the figure, NT-proBNP: N-terminal pro B-type natriuretic peptide, Trop I: Troponin-I, ROC: Receiver operating characteristics, ROSC: Return of spontaneous circulation
Figure 2
Figure 2
Forest plots showing predictors of various cardiac arrest outcomes, i.e. (a) No-ROSC, (b) Poor 24-h survival, (c) In-hospital mortality, (d) Poor 7-days survival. Predictors with bars in red colour depicts significant association with the outcome being studied. IHCA: In-hospital cardiac arrest, NT-proBNP: N-terminal pro B-type natriuretic peptide, ROSC: Return of spontaneous circulation
Figure 3
Figure 3
ROC curve of various point-of-care test for prediction of “24-h mortality”. Blood pH was not shown in the figure, NT-proBNP: N-terminal pro B-type natriuretic peptide, Trop I: Troponin-I, ROC: Receiver operating characteristics
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Damluji AA, Al-Damluji MS, Pomenti S, Zhang TJ, Cohen MG, Mitrani RD, et al. Health care costs after cardiac arrest in the United States. Circ Arrhythm Electrophysiol. 2018;11:e005689. - PubMed
    1. Nolan JP, Maconochie I, Soar J, Olasveengen TM, Greif R, Wyckoff MH, et al. Executive summary:2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2020;142:S2–27. - PubMed
    1. Shin J, Lim YS, Kim K, Lee HJ, Lee SJ, Jung E, et al. Initial blood pH during cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients: A multicenter observational registry-based study. Crit Care. 2017;21:322. - PMC - PubMed
    1. Schnaubelt S, Monsieurs KG, Semeraro F, Schlieber J, Cheng A, Bigham BL, et al. Clinical outcomes from out-of-hospital cardiac arrest in low-resource settings –A scoping review. Resuscitation. 2020;156:137–45. - PubMed
    1. Momiyama Y, Yamada W, Miyata K, Miura K, Fukuda T, Fuse J, et al. Prognostic values of blood pH and lactate levels in patients resuscitated from out-of-hospital cardiac arrest. Acute Med Surg. 2017;4:25–30. - PMC - PubMed