Combination of hemoglobin and low-flow duration can predict neurological outcome in the initial phase of out-of-hospital cardiac arrest

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Purpose:To predict neurological outcome following out-of-hospital cardiac arrest (OHCA) using a combination of hemoglobin (Hb) and low-flow duration (LFD).Materials and methods:We retrospectively examined 131 patients (75 ± 13 years, 64 men) with return of spontaneous circulation (ROSC) following non-traumatic OHCA. The LFD was the duration from the start of cardiopulmonary resuscitation to ROSC. To obtain the Hb/LFD value, we divided the Hb level by the LFD. Multivariate logistic regression analyses were performed to predict full neurological recovery (FNR), defined as Cerebral Performance Category scale scores of 1 or 2 at discharge.Results:Nineteen patients (15%) achieved FNR. Patients with FNR had high Hb levels (14.9 ± 2.1 vs. 11.3 ± 2.7 g/dl, p = 0.001) and short LFDs (10 [5, 18] vs. 35 [28, 43] min, p = 0.001). Multivariate analyses identified the initial ventricular fibrillation rhythm and Hb/LFD as significant predictors for FNR (odds ratio: 24.9, 3.58; p = 0.001, 0.02, respectively). Receiver operating characteristic (ROC) curve analyses indicated that a high Hb/LFD predicted FNR (cut-off value: 0.50, sensitivity: 94.7%, specificity: 84.5%, area under the curve: 0.933).Conclusions:Patients with FNR following OHCA had high Hb levels and short LFDs; the Hb/LFD value significantly predicted FNR.HighlightsHemoglobin (Hb) and Low-flow duration (LFD) could predict neurological outcome of out-of-hospital cardiac arrest (OHCA).We hypothesize that both Hb and LFD could reflect the burden of cerebral ischemia during cardiac arrest.In the present study, patients who achieved full neurological recovery (FNR) following OHCA had high Hb and short LFD.Multivariate analysis reveals that Hb/LFD could be a significant predictor for FNR along with initial VF rhythm.

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