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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

Pediatric Critical Care Medicine: October 2013 - Volume 14 - Issue 8 - p e380–e387
doi: 10.1097/PCC.0b013e3182976402
Online Clinical Investigations

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.

1Division of Pediatric Critical Care, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

2Department of Pediatrics, University of Utah, Salt Lake City, UT.

3Department of Pediatrics, Children’s National Medical Center, Washington, DC.

4Department of Pediatrics, Children’s Hospital of New York, Columbia University, New York, NY.

5Department of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI.

* See also p. 831.

Dr. Topjian is funded by a National Institutes of Health (NIH) career development award K23NS075363 and U01HL094345. Dr. Dean is funded by NIH awards K12HD047349, U01HD049934, U01HL094339, HRSA award U03MC00008, and the HA and Edna Benning Presidential Endowment. Dr. Moler was supported by federal grants NIH NICHD R21 HD044955 and R34 HD 050531. The Pediatric Emergency Care Applied Research Network is supported by cooperative agreements U03MC00001, U03MC00003, U03MC00006, U03MC00007, and U03MC00008 from the Emergency Medical Services for Children program of the Maternal and Child Health Bureau, Health Resources and Services Administration, and U.S. Department of Health and Human Services. Dr. Topjian is employed by CHOP and received grant support from NIH. Dr. Clark received grant support from NIH. Dr. Casper disclosed that he does not have any potential conflicts of interest. Dr. Berger received grant support from NIH. Dr. Schelein served as a board member for Out2Play, provided expert testimony for multiple law firms, received royalties from Kluwers for two textbooks, has stock options with PingMD (equity position in a startup of a smart phone-based product linking parents to pediatricians), and received funding from NIH. Dr. Dean received grant support from NIH (multiple) and EMSC. Dr. Moler received grant and support for travel from NICHD/NIH, NHLBI (THAPCA), NHLBI (HIP), NICHD (CPCCRN), and HRSA/PECARN.

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