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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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Article Info
Publication History
Accepted:
October 26,
1984
Footnotes
☆Presented at the Fifth Purdue Conference on CPR and Defibrillation, West Lafayette, Indiana, September 25–26, 1984.
Identification
Copyright
© 1985 Published by Elsevier Inc.
