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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Article info
Publication history
Published online: December 29, 2020
Accepted:
December 15,
2020
Received in revised form:
November 24,
2020
Received:
August 2,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
