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The association of pH values during the first 24 h with neurological status at hospital discharge and futility among patients with out-of-hospital cardiac arrest

  • Rahaf Al Assil
    Correspondence
    Corresponding author at: Department of Medicine, St. Paul’s Hospital, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.
    Affiliations
    Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada

    Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

    Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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  • Joel Singer
    Affiliations
    Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
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  • Matthieu Heidet
    Affiliations
    Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, SAMU 94 et Urgences, Créteil, France

    Université Paris-Est Créteil (UPEC), EA-4390 (Analysis of Risks in Complex Health Systems - ARCHES), Créteil, France

    Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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  • Christopher B. Fordyce
    Affiliations
    Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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  • Frank Scheuermeyer
    Affiliations
    Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada

    Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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  • Sean van Diepen
    Affiliations
    Department of Critical Care and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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  • Mypinder Sekhon
    Affiliations
    Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

    BC Emergency Health Services, British Columbia, Canada
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  • K.H. Benjamin Leung
    Affiliations
    Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
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  • Rob Stenstrom
    Affiliations
    Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada

    Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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  • Jim Christenson
    Affiliations
    Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada

    Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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  • Brian Grunau
    Affiliations
    Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada

    Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada

    BC Emergency Health Services, British Columbia, Canada
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      Abstract

      Study objective

      Post-resuscitation prognostic biomarkers for out-of-hospital cardiac arrest (OHCA) outcomes have not been fully elucidated. We examined the association of acid-base blood values (pH) with patient outcomes and calculated the pH test performance to predict prognosis.

      Methods

      This was a post-hoc analysis of data from the continuous chest compression trial, which enrolled non-traumatic adult emergency medical system-treated OHCA in Canada and the United States. We examined cases who survived a minimum of 24 h post hospital arrival. The independent variables of interest were initial pH, final pH, and the change in pH (δpH). The primary outcome was neurological status at hospital discharge, with favorable status defined as modified Rankin Scale (mRS) ≤ 3. We reported adjusted odds ratios for favorable neurological outcome using multivariable logistic regression models. We calculated the test performance of increasing pH thresholds in 0.1 increments to predict unfavorable neurological status (defined as mRS >3) at hospital discharge.

      Results

      We included 4189 patients. 32% survived to hospital discharge with favorable neurological status. In the adjusted analysis, higher initial pH (OR 6.82; 95% CI 3.71–12.52) and higher final pH (OR 7.99; 95% CI 3.26−19.62) were associated with higher odds of favorable neurological status. pH thresholds with highest positive predictive values were initial pH < 6.8 (92.5%; 95% CI 86.2 %–98.8%) and final pH < 7.0 (100%; 95% CI 95.2 %–100%).

      Conclusion

      In patients with OHCA, pH values were associated with patients’ subsequent neurological status at hospital discharge. Final pH may be clinically useful to predict unfavorable neurological status at hospital discharge.

      Keywords

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