Acute cardiac care & resuscitation
Treatment effects of blood pressure targets and hemodynamics according to initial blood lactate levels in comatose out-of-hospital cardiac arrest patients – A sub study of the BOX trial
Authors' conclusion
Comatose OHCA patients with high initial lactate levels required more vasoactive drugs on the first two days of ICU admission to meet the blood pressure target and had a poorer prognosis. No indication that aiming for a higher MAP target is beneficial in patients with an initial high lactate level was found
Study context
- Population
- Adult resuscitated comatose out-of-hospital cardiac arrest (OHCA) patients with presumed cardiac cause
- Participants
- 789 participants
- Comparison
- MAP target 77 mmHg vs 63 mmHg according to initial lactate level
- Low-lactaten = 201
- Medium-lactaten = 388
- High-lactaten = 197
- Primary endpoint
- Mortality; effect modification of MAP targets by lactate level
- Follow-up
- 365 days
Methodological detailspost-hoc, sub-study
- Post-hoc
- Sub-study
Primary result
As reported in the abstract
Mortality at 365 days by initial lactate level (MAP 77 vs 63 mmHg)
MAP 77 mmHg vs MAP 63 mmHgOdds ratio (95% CI)
Highest lactate group; mortality 100/197 (51%)
1.7(0.9–3.0)
Lowest lactate group; mortality 35/201 (17%)
1.1(0.5–2.3)
- Initial lactate (continuous) modified the effect of the two MAP targets
- P = 0.04
Further findings
| Outcome | Difference (mmHg) (95% CI) | P value | |
|---|---|---|---|
| Admission MAP, high-lactate vs other groups — High-lactate vs Medium-lactate · lower in high-lactate | 2.6 (0.1–5.0) | P = 0.02 | |
| Admission MAP, high-lactate vs other groups — High-lactate vs Low-lactate · lower in high-lactate | 3.6 (0.8–6.5) | P < 0.01 | |
| −50510Difference, mmHg (linear scale) |
| Outcome | Difference (95% CI) | P value | |
|---|---|---|---|
| Vasoactive inotropic score — High-lactate vs Low-lactate · higher | 79% (42%–124%) | ||
| Vasoactive inotropic score — High-lactate vs Low-lactate · at 6 hours, higher | 110.6% (54.4%–187.2%) | ||
| −1000100200Difference (linear scale) |
Cardiac index, systemic vascular resistance
- No difference between lactate groups
Original publication
Treatment effects of blood pressure targets and hemodynamics according to initial blood lactate levels in comatose out-of-hospital cardiac arrest patients – A sub study of the BOX trial. Resuscitation. Published 18 October 2023. doi:10.
Summarised from the published abstract; every number is checked against it