Lactate Level and Clearance as Predictors of Neurologic Outcome After Cardiopulmonary Resuscitation

Background Cardiac arrest with subsequent cardiopulmonary resuscitation is common in emergency medicine and is often associated with an unfavorable neurologic outcome. Lactate level corresponds to the severity of tissue hypoxia and damage and thus could be useful in predicting neurologic outcome. Objectives To investigate whether lactate and its clearance can serve as early prognostic biomarkers of neurologic outcome after cardiopulmonary resuscitation. Methods This study was a retrospective analysis of 249 patients of the Kliniken Maria Hilf hospital who survived at least 12 hours after cardiac arrest and cardiopulmonary resuscitation between 2012 and 2020. Multivariable logistic regressions were performed to correlate the neurologic outcome with lactate level, lactate clearance, and treatment-related patient data to identify factors that are predictors of neurologic outcome. Results A lactate level greater than 4.2 mmol/L at admission was significantly associated with an unfavorable neurologic outcome. Among patients with a lactate level greater than 4.2 mmol/L at admission, lactate clearance at 24 hours after admission that was greater than 80.9% was associated with a significant decrease in the probability of an unfavorable neurologic outcome. Conclusions These results suggest that lactate and its clearance have an impact on neurologic outcome and can be used as prognostic biomarkers and in treatment decision-making in patients with cardiac arrest and successful resuscitation.