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

Ervigio Corral Torres, Alberto Hernández-Tejedor, Rosa Suárez Bustamante, Ramón de Elías Hernández, Isabel Casado Flórez, Antonio San Juan Linares, Ervigio Corral Torres, Alberto Hernández-Tejedor, Rosa Suárez Bustamante, Ramón de Elías Hernández, Isabel Casado Flórez, Antonio San Juan Linares

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.

Keywords: Blood gases; Emergency medical services; Hydrogen-ion concentration; Out-of-hospital cardiac arrest.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study scenario. Central green boxes summarise data from all the records included. CPC I-II percentages are out of all patients, not out of patients who recovered spontaneous circulation
Fig. 2
Fig. 2
a Relationship between the percentages of recovery of spontaneous circulation (ROSC) and 30-day survival with good neurological outcome (CPC I-II) and the values of pH and pCO2 expressed in ranges evaluated in the multivariate binary logistic regression. b Relationship between the percentages of survival with good neurological outcome (CPC I-II) and the values of base excess (BE) and K+ expressed in ranges evaluated in the multivariate binary logistic regression. Venous blood-gas variables, including alterations in blood potassium, are associated with neurological outcomes. Low pH, a raised pCO2 and a high base deficit, as well as either very low or high blood concentration of potassium, were associated with worse outcome

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Source: PubMed

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