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Pediatric Critical Care Medicine:
doi: 10.1097/PCC.0b013e3182976402
Online Clinical Investigations

Early Lactate Elevations Following Resuscitation From Pediatric Cardiac Arrest Are Associated With Increased Mortality*

Topjian, Alexis A. MD, MSCE1; Clark, Amy E. MS2; Casper, T. Charles PhD2; Berger, John T. MD3; Schleien, Charles L. MD, MBA4; Dean, J. Michael MD, MBA2; Moler, Frank W. MD, MS5; for the Pediatric Emergency Care Applied Research Network

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Abstract

Objective: To describe the association of lactate levels within the first 12 hours after successful resuscitation from pediatric cardiopulmonary arrest with hospital mortality.

Design: Retrospective cohort study.

Setting: Fifteen children’s hospital associated with the Pediatric Emergency Care Applied Research Network.

Patients: Patients between 1 day and 18 years old who had a cardiopulmonary arrest, received chest compressions more than 1 minute, had a return of spontaneous circulation more than 20 minutes, and had lactate measurements within 6 hours of arrest.

Interventions: None.

Measurements and Main Results: Two hundred sixty-four patients had a lactate sampled between 0 and 6 hours (lactate0–6) and were evaluable. Of those, 153 patients had a lactate sampled between 7 and 12 hours (lactate7–12). One hundred thirty-eight patients (52%) died. After controlling for arrest location, total number of epinephrine doses, initial rhythm, and other potential confounders, the odds of death per 1 mmol/L increase in lactate0–6 was 1.14 (1.08, 1.19) (p < 0.001) and the odds of death per 1 mmol/L increase in lactate7–12 was 1.20 (1.11, 1.30) (p < 0.0001). Area under the curve for in-hospital arrest mortality for lactate0–6 was 0.72 and for lactate7–12 was 0.76. Area under the curve for out-of-hospital arrest mortality for lactate0–6 was 0.8 and for lactate7–12 was 0.75.

Conclusions: Elevated lactate levels in the first 12 hours after successful resuscitation from pediatric cardiac arrest are associated with increased mortality. Lactate levels alone are not able to predict outcomes accurately enough for definitive prognostication but may approximate mortality observed in this large cohort of children’s hospitals.

©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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