Veno‐arterial CO₂ difference and lactate for prediction of early mortality after cardiac arrest

Abstract Patients admitted to intensive care after cardiac arrest are at risk of circulatory shock and early mortality due to cardiovascular failure. The aim of this study was to evaluate the ability of the veno‐arterial pCO 2 difference (∆pCO 2 ; central venous CO 2 – arterial CO 2 ) and lactate to predict early mortality in postcardiac arrest patients. This was a pre‐planned prospective observational sub‐study of the target temperature management 2 trial. The sub‐study patients were included at five Swedish sites. Repeated measurements of ∆pCO 2 and lactate were conducted at 4, 8, 12, 16, 24, 48, and 72 h after randomization. We assessed the association between each marker and 96‐h mortality and their prognostic value for 96‐h mortality. One hundred sixty‐three patients were included in the analysis. Mortality at 96 h was 17%. During the initial 24 h, there was no difference in ∆pCO 2 levels between 96‐h survivors and non‐survivors. ∆pCO 2 measured at 4 h was associated with an increased risk of death within 96 h (adjusted odds ratio: 1.15; 95% confidence interval [CI]: 1.02–1.29; p = .018). Lactate levels were associated with poor outcome over multiple measurements. The area under the receiving operating curve to predict death within 96 h was 0.59 (95% CI: 0.48–0.74) and 0.82 (95% CI: 0.72–0.92) for ∆pCO 2 and lactate, respectively. Our results do not support the use of ∆pCO 2 to identify patients with early mortality in the postresuscitation phase. In contrast, non‐survivors demonstrated higher lactate levels in the initial phase and lactate identified patients with early mortality with moderate accuracy.