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Objectives: To determine whether early lactate reduction is associated with improved survival and good neurologic outcome in patients with out-of-hospital cardiac arrest.Design: Ad hoc data analysis of a prospective, multicenter observational study.Setting: Out-of-hospital cardiac arrest patients at 67 emergency hospitals in Kanto, Japan between January 2012 and March 2013.Patients: Adult patients with out-of-hospital cardiac arrest admitted to the hospital after successful resuscitation were identified.Interventions: Blood lactate concentrations were measured at hospital admission and 6 h after hospital admission. Early lactate clearance was defined as the percent change in lactate level 6 h after a baseline measurement.Measurements and Main Results: The 543 patients (mean age, 65 ± 16 yr; 72.6% male) had a mean lactate clearance of 42.4% ± 53.7%. Overall 30-day survival and good neurologic outcome were 47.1% and 27.4%, respectively. The survival proportion increased with increasing lactate clearance (quartile 1, 29.4%; quartile 2, 42.6%; quartile 3, 51.5%; quartile 4, 65.2%; p < 0.001). Multivariate logistic regression analysis showed that lactate clearance quartile was an independent predictor of the 30-day survival and good neurologic outcome. In the Cox proportional hazards model, the frequency of mortality during 30 days was significantly higher for patients with lactate clearance in quartile 1 (hazard ratio, 3.12; 95% CI, 2.14-4.53), quartile 2 (hazard ratio, 2.13; 95% CI, 1.46-3.11), and quartile 3 (hazard ratio, 1.49; 95% CI, 1.01-2.19) than those with lactate clearance in quartile 4. Furthermore, multivariate logistic regression analysis revealed that lactate clearance was a significant predictor of good neurologic outcome at 30 days after hospital admission.Conclusions: Effective lactate reduction over the first 6 hours of postcardiac arrest care was associated with survival and good neurologic outcome independently of the initial lactate level. [ABSTRACT FROM AUTHOR]

Background: While studies have shown that the first documented rhythm is associated with clinical outcome in patients with cardiac arrest, little is known about the difference in clinical outcomes between two types of shockable rhythm (i.e., pulseless ventricular tachycardia [p-VT] and ventricular fibrillation [VF]) among patients with out-of-hospital cardiac arrest (OHCA). Methods: Using a nationwide, prospective population-based OHCA database from 2011 to 2015, we included witnessed adult (aged ≥18 years) patients. Patients who were used public-automated external defibrillator were excluded because of the unavailability of the first documented rhythm. The primary outcome was favorable 30-day neurological survival. To determine the association of the first documented rhythm with outcome, we used logistic regression model with adjustment for patient-level factors (age, sex, etiology of OHCA and incidence year) and prehospital care-related factors (type of witness, bystander cardiopulmonary resuscitation status, and time interval from collapse to the first defibrillation). Results: A total of 22,506 witnessed OHCA patients (median age, 68 years; male, 77%) having shockable rhythm as the first documented rhythm were included: 809 (3.6%) were p-VT and 21,697 (96.4%) were VF. Compared to VF patients, p-VT patients were older (median, 77 years vs. 67 years, p<0.0001), less likely to be male (61.6% vs. 77.6%, P<0.001), less likely to be cardiogenic (69.3% vs. 89.0%, p<0.001), more likely to be witnessed by EMS personnel (43.1% vs. 11.1%, P<0.001) and had shorter time from collapse to the first defibrillation (median, 6 min vs. 11 min, p<0.001). P-VT patients had a higher ROSC rate (40.2% vs. 33.9%, P<0.001), but there was no difference in favorable 30-day neurological survival (23.4% vs. 22.1%, P=0.38). After adjustment for patient-level and prehospital care-related factors, p-VT was associated with better ROSC and favorable 30-day neurological survivalrates with corresponding adjusted odds ratios of 1.86 (95% CI, 1.52-2.27, P<0.001) and 1.59 (95% CI 1.27-1.99, P<0.001). Conclusion: In this nation-wide population-based study of OHCA, patients with p-VT as the first documented rhythm had significantly better outcome compared to those with VF. [ABSTRACT FROM AUTHOR]

Objectives: Bradycardia during therapeutic hypothermia has been reported to be a predictor of favorable neurologic outcomes in out-of-hospital cardiac arrests. However, bradycardia occurrence rate may be influenced by the target body temperature. During therapeutic hypothermia, as part of the normal physiologic response, heart rate decreases in the cooling phase and increases during the rewarming phase. We hypothesized that increased heart rate during the rewarming phase is another predictor of favorable neurologic outcomes. To address this hypothesis, the study aimed to examine the association between heart rate response during the rewarming phase and neurologic outcomes in patients having return of spontaneous circulation after out-of-hospital cardiac arrest.Design: A secondary analysis of the Japanese Population-based Utstein style study with defibrillation and basic/advanced Life Support Education and implementation-Hypothermia registry, which was a multicenter prospective cohort study.Setting: Fourteen hospitals throughout Japan.Patients: Patients suffering from out-of-hospital cardiac arrest who received therapeutic hypothermia after the return of spontaneous circulation from 2005 to 2011.Intervention: None.Measurements and Main Results: This study enrolled 452 out-of-hospital cardiac arrest patients, of which 354 were analyzed, and 80.2% survived to hospital discharge, of which 57.3% had a good neurologic outcome. Heart rate response was calculated using heart rate data recorded during therapeutic hypothermia in the abovementioned registry. Heart rate response in the rewarming phase (heart rate response-rewarming) was calculated as follows: (heart rate [post rewarming]-heart rate [pre rewarming])/heart rate (pre rewarming) × 100. The primary outcome was an unfavorable neurologic outcome at hospital discharge, that is, a Cerebral Performance Category of 3-5. Multivariable logistic regression analysis was performed to determine the association between heart rate response-rewarming and unfavorable neurologic outcomes. Multivariable logistic regression analysis showed that heart rate response-rewarming was independently associated with unfavorable outcomes (odds ratio [per 10% change], 0.86; 95% CI, 0.78-0.96; p = 0.004).Conclusions: Increased heart rate in the approximately 48-hour rewarming phase during therapeutic hypothermia was significantly associated with and was an independent predictor of favorable neurologic outcomes during out-of-hospital cardiac arrest. [ABSTRACT FROM AUTHOR]