The association between hemoglobin concentration and neurologic outcome after cardiac arrest |
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| Affiliation: | 1. Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA;2. Division of Emergency Medicine, University of Washington, Seattle, WA;3. OhioHealth, Columbus, OH;4. Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO;5. School of Public Health, Drexel University, Philadelphia, PA;6. Department of Emergency Medicine, Medstar-Washington Hospital Center, Washington, DC;7. Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA;8. Center for Resuscitation Science, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA;1. Department of Internal Medicine and Rheumatology, Martini Hospital, Groningen, The Netherlands;2. Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands;3. Association of Dutch Burn Centers, Burn centre, Martini Hospital, Groningen, The Netherlands;1. II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität Münche, Munich, Germany;2. Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany;3. Mikrobiologisches Institut, Universitätsklinik Erlangen und Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany;1. Feik School of Pharmacy, University of the Incarnate Word, San Antonio, TX 78209;2. Audie L. Murphy Division, South Texas Veterans Health Care System, San Antonio, TX 78229;3. College of Pharmacy, The University of Texas at Austin, Austin, TX 78712;4. Pharmacotherapy Education and Research Center, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229;5. Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229;6. University of Connecticut School of Medicine, Farmington, CT 06030;7. Section of General Internal Medicine, VA North Texas Health Care System, Dallas, TX 75216;8. Division of General Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX 75390;1. Department of Anesthesiology, Mayo Clinic, Rochester, MN;2. Department of Medicine, University of Calgary, Calgary, AB, Canada;3. Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada;4. Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada;5. Department of Anesthesiology, University of California, San Diego, La Jolla, CA;1. The Ottawa Hospital, Ottawa, Ontario, Canada;2. University of Ottawa, Ottawa, Ontario, Canada;1. University of Georgia College of Pharmacy, Albany, GA, USA;2. Augusta University Medical College of Georgia, Albany, GA, USA;3. University of Maryland, Department of Anesthesiology, 22 South Greene Street, S11C00, Baltimore, MD 21201, USA;4. Grady Health System, Department of Pharmacy and Drug Information, 80 Jesse Hill Jr Drive, Atlanta, GA 30303, USA;5. Emory University Hospital, Department of Pharmaceutical Services, Atlanta, GA, USA;6. Mercer University College of Pharmacy, 1364 Clifton Road NE, Atlanta, GA 30322, USA |
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| Abstract: | PurposeThe purpose of the study is to determine the association between hemoglobin concentration (Hgb) and neurologic outcome in postarrest patients.MethodsWe conducted a retrospective cohort study using the Penn Alliance for Therapeutic Hypothermia (PATH) cardiac arrest registry. Inclusion criteria were resuscitated cardiac arrest (inhospital or out of hospital) and an Hgb value recorded within 24 hours of return of spontaneous circulation. The primary outcome was favorable neurologic status at hospital discharge. Survival to hospital discharge was a secondary outcome.ResultsThere were 598 eligible patients from 21 hospitals. Patients with favorable neurologic outcome had significantly higher median Hgb in the first 2 hours (12.7 vs 10.5 g/dL; P < .001) and 6 hours (12.6 vs 10.6 g/dL; P < .001) postarrest. Controlling for age, pulseless rhythm, etiology, location of arrest, receipt of targeted temperature management, hematologic or metastatic malignancy, or preexisting renal insufficiency, there was a significant relationship between Hgb and neurologic outcome within the first 6 hours after arrest (odds ratio, 1.23; 95% confidence interval, 1.09-1.38) and survival to hospital discharge (odds ratio, 1.20; 95% confidence interval, 1.08-1.34).ConclusionHigher Hgb after cardiac arrest is associated with favorable neurologic outcome, particularly within the first 6 hours. It is unclear if this effect is due to impaired oxygen delivery or if Hgb is a marker for more severe illness. |
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