Relative tachycardia is associated with poor outcomes in post-cardiac arrest patients regardless of therapeutic hypothermia - 07/08/18

Doi : 10.1016/j.ajem.2018.06.032

Jung-In Ko ^a, Kyung Su Kim, MD, PhD ^a,^{^⁎} , Gil Joon Suh ^a,^b, Kyuseok Kim ^b, Woon Yong Kwon ^a,^b, Jonghwan Shin ^b,^c, You Hwan Jo ^b,^d, Yoon Sun Jung ^a, Taegyun Kim ^a, So Mi Shin ^a
^a Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
^b Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
^c Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
^d Department of Emergency Medicine, Seoul National Bundang Hospital, Seongnam-si, Republic of Korea

^⁎Corresponding author at: Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-Ro, Chongno-gu, Seoul 110-744, Republic of Korea.Department of Emergency MedicineSeoul National University Hospital101 Daehak-Ro, Chongno-guSeoul110-744Republic of Korea

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Abstract

Background

To investigate whether the relationship between heart rate and neurological outcome is independent of therapeutic hypothermia (TH) and whether heart rate is related to hemodynamic instability post-cardiac arrest.

Methods

Retrospective review of an out-of-hospital cardiac arrest registry was performed. The primary exposure was heart rate quartiles at 24 h post-cardiac arrest. The primary outcome was a poor neurological outcome, which was defined as having a cerebral performance category (CPC) of 3–5 at 28 days. Secondary outcomes were mean blood pressure and serum lactate at 24 h and Sequential Organ Failure Assessment (SOFA) scores at admission.

Results

In total, 155 patients were enrolled. The proportion of patients with a poor CPC was significantly greater in higher heart rate quartiles; similar results were observed in patients who did and did not undergo TH. Serum lactate levels at 24 h were significantly higher in the 3rd and 4th quartile groups than in the 1st quartile group. Additionally, SOFA scores were significantly higher in the 4th quartile group than in the 1st and 3rd quartile groups.

Conclusions

Relative tachycardia is associated with poor neurological outcomes in post-cardiac arrest patients, independent of TH, and with higher serum lactate levels and admission SOFA scores.

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Keywords : Cardiac arrest, Heart rate, Therapeutic hypothermia, Prognosis