Prognostic value of venous blood analysis at the start of CPR in non-traumatic out-of-hospital cardiac arrest: association with ROSC and the neurological outcome
Abstract Background The knowledge of new prognostic factors in out-of-hospital cardiac arrest (OHCA) that can be evaluated since the beginning of cardiopulmonary resuscitation (CPR) manoeuvres could be helpful in the decision-making process of prehospital care. We aim to identify metabolic variables...
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doaj-2eabb710ccbe49a99104b26f672a3ef22020-11-25T02:06:21ZengBMCCritical Care1364-85352020-02-012411810.1186/s13054-020-2762-5Prognostic value of venous blood analysis at the start of CPR in non-traumatic out-of-hospital cardiac arrest: association with ROSC and the neurological outcomeErvigio Corral Torres0Alberto Hernández-Tejedor1Rosa Suárez Bustamante2Ramón de Elías Hernández3Isabel Casado Flórez4Antonio San Juan Linares5SAMUR-Protección CivilSAMUR-Protección CivilSAMUR-Protección CivilSAMUR-Protección CivilSAMUR-Protección CivilSAMUR-Protección CivilAbstract Background The knowledge of new prognostic factors in out-of-hospital cardiac arrest (OHCA) that can be evaluated since the beginning of cardiopulmonary resuscitation (CPR) manoeuvres could be helpful in the decision-making process of prehospital care. We aim to identify metabolic variables at the start of advanced CPR at the scene that may be associated with two main outcomes of CPR (recovery of spontaneous circulation (ROSC) and neurological outcome). Methods Prospective observational study of all non-traumatic OHCA in patients older than 17 years assisted by emergency medical services (EMS), with doctor and nurse on board, between January 2012 and December 2017. Venous blood gases were sampled upon initially obtaining venous access to determine the initial values of pH, pCO2, HCO3 −, base excess (BE), Na+, K+, Ca2+ and lactate. ROSC upon arrival at the hospital and neurological status 30 days later (Cerebral Performance Categories (CPC) scale) were recorded. Results We included 1552 patients with OHCA with blood test data in a 6-year period. ROSC was achieved in 906 cases (58.4%), and good neurological recovery at 30 days (CPC I-II) occurred in 383 cases (24.68%). In multivariate analysis, we found a significant relationship between non-recovery of spontaneous circulation (no-ROSC) and low pH levels (adjusted odds ratio (OR) 0.03 (0.002–0.59), p = 0.020), high pCO2 levels (adjusted OR 1.03 [1.01–1.05], p = 0.008) and high potassium levels (adjusted OR 2.28 [1.43–3.61], p = 0.008). Poor neurological outcomes were associated with low pH levels (adjusted OR 0.06 [0.02–0.18], p < 0.001), high pCO2 (adjusted OR 1.05 [1.03–1.08], p < 0.001), low HCO3 − (adjusted OR 0.97 [0.94–0.999], p = 0.044), low BE (adjusted OR 0.96 [0.93–0.98], p < 0.001) and high potassium levels (adjusted OR 1.37 [1.16–1.60], p < 0.001). Conclusion There is a significant relationship between severe alterations of venous blood-gas variables and potassium at the start of CPR of non-traumatic OHCA and low-ROSC rate and neurological prognosis.http://link.springer.com/article/10.1186/s13054-020-2762-5Emergency medical servicesOut-of-hospital cardiac arrestBlood gasesHydrogen-ion concentration |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ervigio Corral Torres Alberto Hernández-Tejedor Rosa Suárez Bustamante Ramón de Elías Hernández Isabel Casado Flórez Antonio San Juan Linares |
spellingShingle |
Ervigio Corral Torres Alberto Hernández-Tejedor Rosa Suárez Bustamante Ramón de Elías Hernández Isabel Casado Flórez Antonio San Juan Linares Prognostic value of venous blood analysis at the start of CPR in non-traumatic out-of-hospital cardiac arrest: association with ROSC and the neurological outcome Critical Care Emergency medical services Out-of-hospital cardiac arrest Blood gases Hydrogen-ion concentration |
author_facet |
Ervigio Corral Torres Alberto Hernández-Tejedor Rosa Suárez Bustamante Ramón de Elías Hernández Isabel Casado Flórez Antonio San Juan Linares |
author_sort |
Ervigio Corral Torres |
title |
Prognostic value of venous blood analysis at the start of CPR in non-traumatic out-of-hospital cardiac arrest: association with ROSC and the neurological outcome |
title_short |
Prognostic value of venous blood analysis at the start of CPR in non-traumatic out-of-hospital cardiac arrest: association with ROSC and the neurological outcome |
title_full |
Prognostic value of venous blood analysis at the start of CPR in non-traumatic out-of-hospital cardiac arrest: association with ROSC and the neurological outcome |
title_fullStr |
Prognostic value of venous blood analysis at the start of CPR in non-traumatic out-of-hospital cardiac arrest: association with ROSC and the neurological outcome |
title_full_unstemmed |
Prognostic value of venous blood analysis at the start of CPR in non-traumatic out-of-hospital cardiac arrest: association with ROSC and the neurological outcome |
title_sort |
prognostic value of venous blood analysis at the start of cpr in non-traumatic out-of-hospital cardiac arrest: association with rosc and the neurological outcome |
publisher |
BMC |
series |
Critical Care |
issn |
1364-8535 |
publishDate |
2020-02-01 |
description |
Abstract Background The knowledge of new prognostic factors in out-of-hospital cardiac arrest (OHCA) that can be evaluated since the beginning of cardiopulmonary resuscitation (CPR) manoeuvres could be helpful in the decision-making process of prehospital care. We aim to identify metabolic variables at the start of advanced CPR at the scene that may be associated with two main outcomes of CPR (recovery of spontaneous circulation (ROSC) and neurological outcome). Methods Prospective observational study of all non-traumatic OHCA in patients older than 17 years assisted by emergency medical services (EMS), with doctor and nurse on board, between January 2012 and December 2017. Venous blood gases were sampled upon initially obtaining venous access to determine the initial values of pH, pCO2, HCO3 −, base excess (BE), Na+, K+, Ca2+ and lactate. ROSC upon arrival at the hospital and neurological status 30 days later (Cerebral Performance Categories (CPC) scale) were recorded. Results We included 1552 patients with OHCA with blood test data in a 6-year period. ROSC was achieved in 906 cases (58.4%), and good neurological recovery at 30 days (CPC I-II) occurred in 383 cases (24.68%). In multivariate analysis, we found a significant relationship between non-recovery of spontaneous circulation (no-ROSC) and low pH levels (adjusted odds ratio (OR) 0.03 (0.002–0.59), p = 0.020), high pCO2 levels (adjusted OR 1.03 [1.01–1.05], p = 0.008) and high potassium levels (adjusted OR 2.28 [1.43–3.61], p = 0.008). Poor neurological outcomes were associated with low pH levels (adjusted OR 0.06 [0.02–0.18], p < 0.001), high pCO2 (adjusted OR 1.05 [1.03–1.08], p < 0.001), low HCO3 − (adjusted OR 0.97 [0.94–0.999], p = 0.044), low BE (adjusted OR 0.96 [0.93–0.98], p < 0.001) and high potassium levels (adjusted OR 1.37 [1.16–1.60], p < 0.001). Conclusion There is a significant relationship between severe alterations of venous blood-gas variables and potassium at the start of CPR of non-traumatic OHCA and low-ROSC rate and neurological prognosis. |
topic |
Emergency medical services Out-of-hospital cardiac arrest Blood gases Hydrogen-ion concentration |
url |
http://link.springer.com/article/10.1186/s13054-020-2762-5 |
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