Monitoring of serum lactate level during cardiopulmonary resuscitation in adult in-hospital cardiac arrest

Chih-Hung Wang, Chien-Hua Huang, Wei-Tien Chang, Min-Shan Tsai, Ping-Hsun Yu, Yen-Wen Wu, Kuan-Yu Hung, Wen-Jone Chen

Serum lactate level may correlate with no-flow and low-flow status during cardiac arrest. Current guidelines have no recommended durations for cardiopulmonary resuscitation (CPR) before transition to the next strategy. We hypothesized that the lactate level measured during CPR could be associated with the survival probability and accordingly be useful in estimating the optimal duration for CPR. We conducted a retrospective observational study in a single medical centre and included adult patients who had suffered an in-hospital cardiac arrest between 2006 and 2012. We used multivariable logistic regression analysis to study the association of lactate level measured during CPR and outcomes. We used generalized additive models to examine the nonlinear effects of continuous variables and conditional effect plots to visualize the estimated survival probability against CPR duration. Of the 340 patients included in our analysis, 50 patients (14.7 %) survived to hospital discharge. The mean lactate level was 9.6 mmol/L and mean CPR duration was 28.8 min. There was an inverse near-linear relationship between lactate level and probability of survival to hospital discharge. A serum lactate level <9 mmol/L was positively associated with patient survival to hospital discharge (odds ratio 2.00, 95 % confidence interval 1.01-4.06). The optimal CPR duration may not be a fixed value but depend on other conditions. Serum lactate level measured during CPR could correlate with survival outcomes. A lactate level threshold of 9 mmol/L may be used as a reference value to identify patients with different survival probabilities and determine the optimal CPR durations.