The following is a summary of “Is the lactate value predictive of the return of spontaneous circulation during CPR in nontraumatic OHCA?,” published in the May 2024 issue of Emergency Medicine by Contenti, et al.

For a study, researchers sought to investigate the potential of blood lactate levels and their changes during cardiopulmonary resuscitation (CPR) as predictors of the return of spontaneous cardiac activity (ROSC) in non-traumatic out-of-hospital cardiac arrest (OHCA).

Between 2017 and 2020, they conducted a prospective, interventional, multi-center study involving patients aged over 18 years (>50 years for women) who experienced non-traumatic OHCA and did not achieve ROSC before EMS arrival. The medical team initiated or continued CPR, and blood lactate levels were measured using a point-of-care (POC) device in both venous and capillary samples.

About 60 patients were included, with a median age of 71 years (IQR: 62–84), and 21.3% were female. Among them, 25% achieved ROSC in the out-of-hospital setting, and 13.3% were alive at day 28. The median venous lactate value at T0 (time of EMS setting up the peripheral venous line) was 6.2 mmol/L (IQR: 4.6–8.1), with no significant difference between patients with or without ROSC (6.4 mmol/L [IQR: 4.7–7.9] vs. 6.2 mmol/L [IQR: 4.7–8], P = 0.87). Variables independently associated with ROSC were initial EtCO2 value (aOR = 1.12; 95% CI 1.01–1.25), initial shockable rhythm (aOR = 10.2; 95% CI 1.18–88.2), and pre-ROSC adrenaline dose (aOR = 0.54; 95% CI 0.35–0.82).

In the prospective multi-center study, blood lactate levels during CPR were not independently associated with ROSC in non-traumatic OHCA cases. However, the kinetics of lactate post-ROSC within the first 30 minutes may have implications for survival. Further research is needed to explore the potential of lactate dynamics as prognostic markers in OHCA.

Reference: sciencedirect.com/science/article/abs/pii/S0735675724000810