The prognostic role of lactate in patients who achieved return of spontaneous circulation after cardiac arrest: A systematic review and meta-analysis

Aim: The aim of the study is to conduct a systematic review and meta-analysis of data showing the association of lactate levels with mortality and neurologic outcome in patients who achieved return of spontaneous circulation (ROSC) after cardiac arrest. Methods: An electronic search of PubMed, Embase, Web of Science, and Cochrane Library databases was conducted. Lactate levels at 0, 6, 12, 24, and 48 h after ROSC in survivors versus nonsurvivors and in good versus poor neurologic outcome patients were extracted. Continuous variable and odds ratio were applied for data analysis. Inverse-variance fixed effects model with 95% confidence interval (CI) was used depending on interstudy heterogeneity. Results: A total of 18 articles meeting the study criteria were included for systematic review and 15 for meta-analysis. The results showed that initial serum lactate levels in nonsurvivors were significantly higher than survivors (standardized mean difference [SMD] = −0.43; 95% CI = [−0.52, −0.33]; P P Conclusions: Higher lactate levels were associated with increased mortality and poor neurologic outcome. Lower lactate levels or faster lactate clearance was associated with higher survival and good neurologic outcome.