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Lactic acidosis as a predictor of downtime during cardiopulmonary arrest in dogs

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      Abstract

      Studies have shown that over 50% of cardiovascular deaths occur before hospitalization. A major factor associated with survival in cases of out-of-hospital cardiac arrest is the time from cardiovascular collapse to the initiation of cardiopulmonary resuscitation (CPR) or “downtime.” The purpose of this study was to determine whether blood lactate levels could be used to predict downtime in the canine cardiac arrest model. Femoral arterial and Swan-Ganz catheters were placed in 22 mongrel dogs, and ventricular fibrillation was electrically induced. The dogs remained in ventricular fibrillation without ventilation for 5, 10, 15, 30, or 60 minutes. After the predetermined fibrillation time, a left anterolateral thoracotomy was performed, and open-chest cardiac massage was begun. Arterial and mixed venous lactate levels were determined for every 5 minutes during 30 minutes of cardiopulmonary resuscitation. The correlation coefficient between the mixed venous and arterial lactate levels was 0.96 or greater during all stages of resuscitation. Peak serum lactate level increased linearly in relation to downtime. The increase in lactate level was not evident until after CPR was begun, and it remained at peak levels or decreased insignificantly, despite optimal open-chest CPR. Linear regression analysis revealed that 84% of the variability in serum lactate levels could be explained by downtime differences. In this model, blood lactate level is a reliable and objective measure of downtime and may be a useful indicator of the adequacy of CPR if levels decrease or remain stable. The clinical implications of this study lie with the use of blood lactate levels in the emergency department to guide the aggressiveness of resuscitative efforts.

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      References

        • Kuller L
        • Lillienfield A
        • Fisher R
        Epidemiological study of sudden and unexpected deaths due to arteriosclerotic heart disease.
        Circulation. 1966; 34: 1056-1068
        • Eisenberg MS
        • Bergner L
        • Hallstrom A
        Cardiac resuscitation in the community: Importance of rapid provision and implications for program planning.
        JAMA. 1979; 241: 1905-1907
        • Eisenberg MS
        • Hallstrom A
        • Berger L
        Long term survival after out-of-hospital cardiac arrest.
        N Engl J Med. 1982; 306: 1340-1343
        • Oliva PB
        Lactic acidosis.
        Am J Med. 1970; 48: 209-225
        • Kreisberg PA
        Lactate homeostasis and lactic acidosis.
        Ann Intern Med. 1980; 29: 227-237
        • Frommer JP
        Lactic acidosis.
        Med Clin North Am. 1983; 67: 815-829
        • Park R
        • Arieff AI
        Lactic acidosis: Current concepts.
        Clin Endocrinol Metab. 1983; 12: 339-358
        • Weil MH
        • Abdelmonen AA
        Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock).
        Circulation. 1970; 41: 989-1001
        • Henning RJ
        • Weil MH
        • Weiner F
        Blood lactate as a prognostic indicator of survival in patients with acute myocardial infarction.
        Circ Shock. 1982; 9: 307-315
        • Marbach EP
        • Weil MH
        Rapid enzymatic measurement of blood lactate and pyruvate: Use and significance of metaphosphoric acid as a common precipitant.
        Clin Chem. 1967; 13: 314-325
        • Greenwood PV
        • Rossall RE
        • Kappagoda CT
        Acid-base changes after cardiorespiratory arrest in the dog.
        Clin Sci. 1980; 58: 127-133
        • Bigger JT
        Definition of benign versus malignant ventricular arrhythmias: Targets for treatment.
        Am J Cardiol. 1983; 52: 47c-54c
        • Peretz DI
        • McGregor M
        • Dossetor JB
        Lactic acidosis: A clinically significant aspect of shock.
        Can Med Assoc J. 1964; 90: 673-675
        • Cady LD
        • Weil MH
        • Affifi AA
        • et al.
        Quantitation of severity of critical illness with special reference to blood lactate.
        Crit Care Med. 1973; 2: 75-80
        • Broder G
        • Weil MH
        Excess lactate: An index of reversibility of shock in human patients.
        Science. 1964; 143: 1457-1459
        • Vincent JL
        • Dufaye P
        • Berre J
        • et al.
        Serial lactate determinations during circulatory shock.
        Crit Care Med. 1983; 11: 449-451
        • Waxman K
        • Nolan LS
        • Shoemaker WC
        Sequential perioperative lactate determination: Physiological and clinical implications.
        Crit Care Med. 1982; 10: 96-99
        • Sundt TM
        • Sharbrough FW
        • Piepgras DG
        • et al.
        Correlation of cerebral blood flow and electroencephalographic changes during carotid endarterectomy: With results of surgery and hemodynamics of cerebral ischemia.
        in: 3rd edition. Mayo Clin Proc. 56. 1981: 533-534
        • Astrup J
        • Symon L
        • Branston NM
        • et al.
        Cortical evoked potential in extracellular k+ and H+ at critical levels of brain ischemia.
        Stroke. 1977; 8: 51
        • Niemann JT
        Differences in cerebral and myocardial perfusion during closed chest resuscitation.
        Ann Emerg Med. 1984; 13: 849-853
        • Lee SK
        • Vaagenes P
        • Safar P
        • et al.
        Effect of cardiac arrest time on the cortical cerebral blood flow generated by subsequent standard external CPR in rabbits (abstract).
        Ann Emerg Med. 1984; 13: 385
        • Koehler RC
        • Chandra N
        • Gujerci AD
        • et al.
        Augmentation of cerebral perfusion by simultaneous chest compression and lung inflation with abdominal binding after cardiac arrest in dogs.
        Circulation. 1983; 67: 266
        • Ralston SH
        • Babbs CF
        • Niebauer MJ
        Cardiopulmonary resuscitation with interposed abdominal compression in dogs.
        Anesth Analg. 1982; 61: 645-651
        • White BC
        • Hildebrandt JH
        • Johns D
        • et al.
        Prolonged cardiac arrest and resuscitation in dogs, II: Brain mitochondrial function after CPR versus interposed abdominal compression CPR (abstract).
        Ann Emerg Med. 1984; 13: 386
        • Stajduhar K
        • Steinberg R
        • Sotosky M
        • et al.
        Cerebral Blood flow and common carotid artery blood flow during open chest CPR in dogs (abstract).
        Ann Emerg Med. 1984; 13: 385
        • Safar P
        Recent advances in cardiopulmonary-cerebral resuscitation: A review.
        Ann Emerg Med. 1984; 13: 856-862