Early prognostic impact of serum sodium level among out-of-hospital cardiac arrest patients: a nationwide multicentre observational study in Japan (the JAAM-OHCA registry).

Haruka Shida, Tasuku Matsuyama, Sho Komukai, Taro Irisawa, Tomoki Yamada, Kazuhisa Yoshiya, Changhwi Park, Tetsuro Nishimura, Takuya Ishibe, Yoshiki Yagi, Takeyuki Kiguchi, Masafumi Kishimoto, Sung-Ho Kim, Yasuyuki Hayashi, Taku Sogabe, Takaya Morooka, Haruko Sakamoto, Keitaro Suzuki, Fumiko Nakamura, Norihiro Nishioka, Yohei Okada, Satoshi Matsui, Satoshi Yoshimura, Shunsuke Kimata, Shunsuke Kawai, Yuto Makino, Taku Iwami, Tetsuhisa Kitamura

Journal: Heart and vessels 2022;37(7):1255-1264

PMID: 35044522

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Abstract

Dysnatremia is an electrolytic disorder commonly associated with mortality in various diseases. However, little is known about dysnatremia in out-of-hospital cardiac arrest (OHCA) cases. Here, we investigated the association between serum sodium level on hospital arrival and neurological outcomes after OHCA. This nationwide hospital-based observational study (The Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest registry) enrolled patients with OHCA between 2014 and 2017. We included adult patients aged ≥ 18 years with non-traumatic OHCA who achieved return of spontaneous circulation (ROSC) and whose serum sodium level on hospital arrival was available. Based on the serum sodium level, patients were divided into three levels: hyponatremia (Na < 135 mEq/L), normal sodium level (Na ≥ 135 or ≤ 145 mEq/L), and hypernatremia (Na > 145 mEq/L). The primary outcome was 1-month survival with favourable neurological outcomes. Altogether, 34 754 patients with OHCA were documented, and 5160 patients with non-traumatic OHCA and who achieved ROSC were eligible for our analyses. The proportion of favourable neurological outcomes was highest in patients with normal sodium levels at 17.6% (677/3854), followed by patients with hyponatremia at 8.2% (57/696) and patients with hypernatremia at 5.7% (35/610). Moreover, hyponatremia and hypernatremia were associated with a decreased probability of favourable neurological outcomes compared with normal sodium level (vs. hyponatremia, adjusted odds ratio [AOR] 0.97, 95% confidence interval [CI] 0.95-0.99; vs. hypernatremia, AOR 0.96, 95% CI 0.94-0.98). Hypo- and hypernatremia on hospital arrival were associated with a decreased probability of favourable neurological outcomes in patients with non-traumatic OHCA who achieved ROSC.

Address: Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan.; Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Chiyoda-ku, Tokyo, Japan.; Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan. [email protected].; Division of Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.; Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan.; Emergency and Critical Care Medical Center, Osaka Police Hospital, Osaka, Japan.; Department of Emergency and Critical Care Medicine, Kansai Medical University, Takii Hospital, Moriguchi, Japan.; Department of Emergency Medicine, Tane General Hospital, Osaka, Japan.; Department of Critical Care Medicine, Osaka City University, Osaka, Japan.; Department of Emergency and Critical Care Medicine, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.; Osaka Mishima Emergency Critical Care Center, Takatsuki, Japan.; Critical Care and Trauma Center, Osaka General Medical Center, Osaka, Japan.; Osaka Prefectural Nakakawachi Medical Center of Acute Medicine, Higashi-Osaka, Japan.; Senshu Trauma and Critical Care Center, Osaka, Japan.; Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Japan.; Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan.; Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan.; Department of Pediatrics, Osaka Red Cross Hospital, Osaka, Japan.; Emergency and Critical Care Medical Center, Kishiwada Tokushukai Hospital, Osaka, Japan.; Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan.; Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan.; Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.; Kyoto University Health Services, Kyoto, Japan.

DOI: 10.1007/s00380-022-02020-3

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https://dx.doi.org/10.1007/s00380-022-02020-3

MeSH Terms: Adult, Cardiopulmonary Resuscitation, Humans, Hypernatremia, Hyponatremia, Japan, Out-of-Hospital Cardiac Arrest, Prognosis, Registries, Sodium