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Usefulness of chloride levels for fluid resuscitation in patients undergoing targeted temperature management after out-of-hospital cardiac arrest

Authors
 Taeyoung Kong  ;  Yong Eun Chung  ;  Hye Sun Lee  ;  Je Sung You  ;  Hyun Soo Chung  ;  Incheol Park  ;  Sung Phil Chung 
Citation
 AMERICAN JOURNAL OF EMERGENCY MEDICINE, Vol.43 : 69-76, 2021-05 
Journal Title
 AMERICAN JOURNAL OF EMERGENCY MEDICINE 
ISSN
 0735-6757 
Issue Date
2021-05
Keywords
Chloride ; Mortality ; Neurologic outcome ; Out-of-hospital cardiac arrest ; Predictor ; Targeted temperature management
Abstract
Objective: Chloride is an important electrolyte in the body. In this study, we aimed to evaluate the associations between chloride levels on emergency department (ED) admission and neurologic outcomes by stratifying patients undergoing targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA) into three groups (hyper/normo/hypochloremia); we also assessed the effect of changes in chloride levels from baseline over time on outcomes. Methods: This retrospective, observational cohort study of 346 patients was conducted between 2011 and 2019. The chloride levels were categorized as hypochloremia, normochloremia, and hyperchloremia by predetermined definitions. The primary endpoint was poor neurologic outcomes after hospital discharge. We evaluated the associations between chloride levels on ED admission and neurologic outcomes and assess the effect of changes in chloride levels over time on clinical outcomes. Results: On ED admission, compared with normochloremia, hypochloremia was significantly associated with unfavorable neurologic outcomes (OR, 2.668; 95% CI, 1.217-5.850, P = 0.014). Over time, unfavorable neurologic outcomes were significantly associated with increases in chloride levels in the hyperchloremia and normochloremia groups after ED admission. The rates of poor neurologic outcomes in the hyperchloremia and normochloremia groups were increased by 14.2% at Time-12, 20.1% at Time-24, and 9.3% at Time-48 with a 1-mEq/L increase in chloride levels. Conclusion: In clinical practice, chloride levels can be routinely and serially measured cost-effectively. Thus, baseline chloride levels may be a promising tool for rapid risk stratification of patients after OHCA. For fluid resuscitation after cardiac arrest, a chloride-restricted solution may be an early therapeutic strategy.
Full Text
https://www.sciencedirect.com/science/article/pii/S0735675721000310
DOI
10.1016/j.ajem.2021.01.027
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kong, Tae Young(공태영) ORCID logo https://orcid.org/0000-0002-4182-7245
Park, In Cheol(박인철) ORCID logo https://orcid.org/0000-0001-7033-766X
You, Je Sung(유제성) ORCID logo https://orcid.org/0000-0002-2074-6745
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
Chung, Sung Phil(정성필) ORCID logo https://orcid.org/0000-0002-3074-011X
Chung, Yong Eun(정용은) ORCID logo https://orcid.org/0000-0003-0811-9578
Chung, Hyun Soo(정현수) ORCID logo https://orcid.org/0000-0001-6110-1495
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/182917
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