• Willemina Sofie Lonsain, Loranne De Lausnay, Lina Wauters, Didier Desruelles, and Philippe Dewolf.
• Department of Emergency Medicine, University Hospitals of Leuven, Leuven, Belgium; KULeuven - University, Department of Public Health and Primary Care, Leuven, Belgium.
• Am J Emerg Med. 2021 Aug 1; 46: 56-62.

BackgroundPrognostication of survival after out-of-hospital cardiac arrest (OHCA) remains challenging with current guidelines recommending the prognostication no earlier than 72 h after return of spontaneous circulation (ROSC). Prognostic factors that could be used earlier after ROSC, like lactate clearance, are still being studied.ObjectivesThis paper aims to investigate the prognostic strength of early lactate clearance for survival after OHCA.MethodsThis retrospective observational single-center study focuses on patients for whom ROSC was achieved after OHCA. Patients ≥18 years admitted between September 2012 and January 2019, for which arterial serum lactate measurements were available immediately at and 3 h after hospital admission (T0 and T3), were included.Results192 patients were included. Lactate clearance at T3 (p < 0.001) was identified as an independent predictor for 24 h, 48 h and 72 h survival. Witnessed arrest, bystander CPR and initial shockable rhythm were independent significant predictors for long term survival after ROSC (1 month, 3 months and 1 year; p < 0.05), but not for 24 h survival. Age (above or below 65 years) was not significant for predicting survival. Upon combination of witnessed arrest, bystander CPR and initial shockable rhythm in a multivariate logistic regression model for long term survival, the initial rhythm was the dominant factor in the combined model, making witnessed arrest and bystander CPR redundant.ConclusionLactate clearance at T3 after ROSC is associated with 24 h, 48 h and 72 h survival. Further research is needed to determine how to incorporate lactate clearance as part of a clinically useful tool to predict long term survival.Copyright © 2021. Published by Elsevier Inc.

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