Haruka Shida1, Tasuku Matsuyama2, Taku Iwami3, Satoe Okabayashi3, Tomoki Yamada4,5, Koichi Hayakawa6, Kazuhisa Yoshiya4, Taro Irisawa4, Kazuo Noguchi7, Tetsuro Nishimura8, Toshifumi Uejima9, Yoshiki Yagi10, Takeyuki Kiguchi3,11, Masafumi Kishimoto12, Makoto Matsuura13, Yasuyuki Hayashi14, Taku Sogabe15, Takaya Morooka16, Junya Sado17, Takefumi Kishimori1, Kosuke Kiyohara18, Takeshi Shimazu4, Tetsuhisa Kitamura19, Takashi Kawamura3. 1. Department of Preventive Services, Kyoto University School of Public Health, Japan. 2. Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Japan. 3. Kyoto University Health Services, Japan. 4. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan. 5. Emergency and Critical Care Medical Center, Osaka Police Hospital, Japan. 6. Department of Emergency and Critical Care Medicine, Kansai Medical University, Takii Hospital, Moriguchi, Japan. 7. Department of Emergency Medicine, Tane General Hospital, Osaka, Japan. 8. Department of Critical Care Medicine, Osaka City University, Japan. 9. Department of Emergency and Critical Care Medicine, Kinki University School of Medicine, Osaka-Sayama, Japan. 10. Osaka Mishima Emergency Critical Care Centre, Takatsuki, Japan. 11. Critical Care and Trauma Center, Osaka General Medical Center, Osaka, Japan. 12. Osaka Prefectural Nakakawachi Medical Center of Acute Medicine, Higashi-Osaka, Japan. 13. Senshu Trauma and Critical Care Center, Osaka, Japan. 14. Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Japan. 15. Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Japan. 16. Emergency and Critical Care Medical Center, Osaka City General Hospital, Japan. 17. Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, Japan. 18. Department of Food Science, Otsuma Women's University, Tokyo, Japan. 19. Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Japan.
Abstract
BACKGROUND: Little is known about the association between serum potassium level on hospital arrival and neurological outcome after out-of-hospital cardiac arrest (OHCA). We investigated whether the serum potassium level on hospital arrival had prognostic indications for patients with OHCA. METHODS: This prospective, multicenter observational study conducted in Osaka, Japan (CRITICAL study) enrolled consecutive patients with OHCA transported to 14 participating institutions from 2012 to 2016. We included adult patients aged ⩾18 years with OHCA of cardiac origin who achieved return of spontaneous circulation and whose serum potassium level on hospital arrival was available. Based on the serum potassium level, patients were divided into four quartiles: Q1 (K ⩽3.8 mEq/L), Q2 (3.8< K⩽4.5 mEq/L), Q3 (4.5< K⩽5.6 mEq/L) and Q4 (K >5.6 mEq/L). The primary outcome was one-month survival with favorable neurological outcome, defined as cerebral performance category scale 1 or 2. RESULTS: A total of 9822 patients were registered, and 1516 of these were eligible for analyses. The highest proportion of favorable neurological outcome was 44.8% (189/422) in Q1 group, followed by 30.3% (103/340), 11.7% (44/375) and 4.5% (17/379) in the Q2, Q3 and Q4 groups, respectively (p<0.001). In the multivariable analysis, the proportion of favorable neurological outcome decreased as the serum potassium level increased (p<0.001). CONCLUSIONS: High serum potassium level was significantly and dose-dependently associated with poor neurological outcome. Serum potassium on hospital arrival would be one of the effective prognostic indications for OHCA achieving return of spontaneous circulation.
BACKGROUND: Little is known about the association between serum potassium level on hospital arrival and neurological outcome after out-of-hospital cardiac arrest (OHCA). We investigated whether the serum potassium level on hospital arrival had prognostic indications for patients with OHCA. METHODS: This prospective, multicenter observational study conducted in Osaka, Japan (CRITICAL study) enrolled consecutive patients with OHCA transported to 14 participating institutions from 2012 to 2016. We included adult patients aged ⩾18 years with OHCA of cardiac origin who achieved return of spontaneous circulation and whose serum potassium level on hospital arrival was available. Based on the serum potassium level, patients were divided into four quartiles: Q1 (K ⩽3.8 mEq/L), Q2 (3.8< K⩽4.5 mEq/L), Q3 (4.5< K⩽5.6 mEq/L) and Q4 (K >5.6 mEq/L). The primary outcome was one-month survival with favorable neurological outcome, defined as cerebral performance category scale 1 or 2. RESULTS: A total of 9822 patients were registered, and 1516 of these were eligible for analyses. The highest proportion of favorable neurological outcome was 44.8% (189/422) in Q1 group, followed by 30.3% (103/340), 11.7% (44/375) and 4.5% (17/379) in the Q2, Q3 and Q4 groups, respectively (p<0.001). In the multivariable analysis, the proportion of favorable neurological outcome decreased as the serum potassium level increased (p<0.001). CONCLUSIONS: High serum potassium level was significantly and dose-dependently associated with poor neurological outcome. Serum potassium on hospital arrival would be one of the effective prognostic indications for OHCA achieving return of spontaneous circulation.
Entities:
Keywords:
Out-of-hospital cardiac arrest; early prognostication; favorable neurological outcome; potassium