In-hospital cardiac arrest (IHCA) is very common in hospitalised adult patients. The survival rate from IHCA has increased over the last few years, presumably because of the earlier recognition of cardiac arrest, higher quality of cardiopulmonary resuscitation (CPR) and improved post-resuscitation care. Even though there has been a lot of progress in this field, mortality following IHCA remains high, with only about an 18 % of survival rate. The authors of this study hypothesized that the lactate level measured during CPR could be associated with the survival probability and be useful in estimating the optimal CPR duration.

340 patients who had suffered an in-hospital cardiac arrest between 2006 and 2012 were included in this retrospective observational cohort study which was carried out in a tertiary medical centre in Taiwan, China. Wang et al. used multivariable logistic regression analysis to study the association of the lactate level measured during CPR and the outcomes.

Of the 340 patients included in this analysis, 50 patients (14.7 %) survived to hospital discharge. The mean lactate level was 9.6 mmol/L and mean CPR duration was 28.8 min. There was an inverse near-linear relationship between lactate level and probability of survival to hospital discharge. A serum lactate level <9 mmol/L was positively associated with patient survival to hospital discharge (odds ratio 2.00, 95% confidence interval 1.01-4.06). The optimal CPR duration may not be a fixed value but depend on other conditions.

Wang et al. concluded that serum lactate level measured during CPR could correlate with survival outcomes. A lactate level threshold of 9 mmol/L may be used as a reference value to identify patients with different survival probabilities and determine the optimal CPR durations.

This article was written in English by Chih-Hung Wang, Chien-Hua Huang, Wei-Tien Chang, Min-Shan Tsai, Ping-Hsun Yu, Yen-Wen Wu, Kuan-Yu Hung and Wen-Jone Chen and published in Critical Care (2015) 19:344 DOI 10.1186/s13054-015-1058-7

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Monitoring of serum lactate level during cardiopulmonary resuscitation in adult in-hospital cardiac arrest