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The strong ion gap and outcome after cardiac arrest in patients treated with therapeutic hypothermia: a retrospective study

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Abstract

Objective

This study investigates whether the strong ion gap (SIG) is associated with long-term outcome after cardiac arrest in patients treated with therapeutic hypothermia. The hypothesis of the study was that an elevated SIG was associated with unfavourable outcome after cardiac arrest.

Design

Retrospective review of records from 1995 to 2007 of patients who received cardiopulmonary resuscitation.

Setting

Emergency department of a university hospital.

Patients

Patients who were successfully resuscitated after cardiac arrest (n = 288) and treated with mild therapeutic hypothermia.

Interventions

None.

Measurements and results

Acid–base variables were calculated according to Stewart’s approach, as modified by Figge and Fencl, and were determined immediately on admission and 12 h after the return of spontaneous circulation. Acid–base variables were determined at 37°C and are reported without correction for patient temperature. Differences in SIG were compared between patients with favourable (survival 6 months with cerebral performance category 1 or 2) and unfavourable outcomes.

SIG on admission and 12 h after return of spontaneous circulation was higher in patients with unfavourable outcome (n = 151; 52%). SIG 12 h after return of spontaneous circulation was identified as an independent predictor of outcome. A SIG > 8.9 mmol/L was associated with an increased cumulative hazard of death.

Conclusions

An elevated SIG 12 h after return of spontaneous circulation may be associated with unfavourable outcome in patients after cardiac arrest treated with mild therapeutic hypothermia. The unmeasured anions hidden behind an elevated SIG may represent markers of tissue damage.

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Acknowledgments

The authors thank Peter Straganz for his help in data abstraction.

Conflict of interest statement

No financial support, including any institutional departmental funds, has been used for this study.

Author information

Authors and Affiliations

  1. Department of Respiratory and Critical Care Medicine, Otto Wagner Spital, Vienna, Austria

    Georg-Christian Funk

  2. Department of Clinical Pharmacology, Medical University of Vienna, Allgemeines Krankenhaus, Vienna, Austria

    Daniel Doberer

  3. Emergency Medicine, Medical University of Vienna, Allgemeines Krankenhaus, Vienna, Austria

    Fritz Sterz, Nina Richling & Philip Eisenburger

  4. Internal Medicine III, Intensive Care Unit 13H1, Medical University of Vienna, Allgemeines Krankenhaus, Vienna, Austria

    Nikolaus Kneidinger & Bruno Schneeweiss

  5. Intensive Care Unit 13I3, Medical University of Vienna, Allgemeines Krankenhaus, Vienna, Austria

    Gregor Lindner

  6. Universitätsklinik für Notfallmedizin, Medizinische Universität Wien, Währinger Gürtel 18–20/6D, 1090, Vienna, Austria

    Fritz Sterz

Authors
  1. Georg-Christian Funk
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  2. Daniel Doberer
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  3. Fritz Sterz
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  4. Nina Richling
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  5. Nikolaus Kneidinger
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  6. Gregor Lindner
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  7. Bruno Schneeweiss
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  8. Philip Eisenburger
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Corresponding author

Correspondence to Fritz Sterz.

Additional information

This article is discussed in the editorial available at: doi:10.1007/s00134-008-1316-0.

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Funk, GC., Doberer, D., Sterz, F. et al. The strong ion gap and outcome after cardiac arrest in patients treated with therapeutic hypothermia: a retrospective study. Intensive Care Med 35, 232–239 (2009). https://doi.org/10.1007/s00134-008-1315-1

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  • DOI: https://doi.org/10.1007/s00134-008-1315-1

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