SESSION TITLE: Critical Care
SESSION TYPE: Slide Presentation
PRESENTED ON: Saturday, March 22, 2014 at 04:15 PM - 05:15 PM
PURPOSE: Point-of-care blood testing for multiple parameters (POCTMP) is often used to assess for reversible etiologies and to guide management during cardiac arrest (CA). However, its role in outcome is unknown.
METHODS: CA records were reviewed at a large academic hospital. POCTMP panel included hematocrit, glucose, sodium, potassium, ionized calcium, pH, PaO2, PaCO2, bicarbonate and base drawn from an arterial blood sample. True CA was defined as patients who received cardiopulmonary resuscitation and either pharmacologic (epinephrine, vasopressin, atropine) or electrical (defibrillation) intervention.
RESULTS: 86 unique patients with 89 CA events met inclusion criteria. 49 (57%) were men and mean age was 70 (SD 14) years. The initial rhythms were: asystole 15 (17%), pulseless electrical activity 42 (47%), ventricular fibrillation 8 (9%), ventricular tachycardia 7 (8%), and unknown 17 (19%). In 13/89 CA events (15%), POCTMP was not obtained. The mean time to obtain the first POCTMP result was 12.5 (SD 4.1) minutes after CA detection. Return of spontaneous circulation (ROSC) was noted in 48/89 (54%) of events. On comparing CA events with ROSC to those without ROSC, time to first POCTMP result was shorter (11.7 vs 13.6 minutes, p=0.02), bicarbonate was higher (24.0 vs 17.9, p=0.0008), PaO2 was higher (109.0 vs 55.9, p=0.018), and potassium was lower (4.8 vs 5.4, p=0.031). Differences in other parameters were not statistically significant. Availability of POCTMP result was not associated with ROSC (OR 1.4, 95% CI 0.4-4.7, p=0.6).
CONCLUSIONS: POCTMP results were obtained after a significant time lapse, and CA survivors had lower mean times to first POCTMP result. POCTMP was not associated with ROSC. However, a larger sample size may be needed to demonstrate benefit.
CLINICAL IMPLICATIONS: The first 10 minutes after detection of CA are regarded as the most critical for patient survival. The mean time to obtain the first POCTMP was over 10 minutes, suggesting more expeditious testing may impact outcomes favorably.
DISCLOSURE: The following authors have nothing to disclose: Sumedh Hoskote, Elizabeth Hassebroek, Shihab Sugeir, Sumanjit Kaur, Aysen Erdogan, James Onigkeit, Jeffrey Jensen
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