Neurological Prognostic Value of Adjusted Ca 2+ Concentration in Adult Patients with Out-of-Hospital Cardiac Arrest: A Preliminary Observational Study

Many patients are transferred to hospital due to out-of-hospital cardiac arrest (OHCA), and, unfortunately, most suffer from cerebral damage. Currently, it is difficult to predict the recovery of neurological function after return of spontaneous circulation (ROSC) in the acute phase. Increased intracellular Ca(2+) induces cell death in the acute phase. Accordingly, we predicted that serum adjusted Ca(2+) will decrease following Ca(2+) influx into cells. Consequently, serum adjusted Ca(2+) in the acute phase may be able to predict recovery of neurological function in patients with ROSC from OHCA. This is a retrospective and observational study from 2 centers. A total of 190 consecutive patients with ROSC from OHCA were recruited, with 33 patients meeting the inclusion criteria. The relationship between serum adjusted Ca(2+) within 48 hours after ROSC and neurological function at discharge (as evaluated by the Glasgow-Pittsburgh cerebral performance category) was examined. Serum adjusted Ca(2+) was measured every 4 hours within a 48-hour period after ROSC. There were no significant differences in hemodynamical state and laboratory data between the 2 groups. However, lowest serum adjusted Ca(2+) within 48 hours after ROSC was significantly lower in the poor neurological outcome group (0.96 +/- 0.06 versus 1.02 +/- 0.06 mmol/L, P = 0.011). Thus, lowest serum adjusted Ca(2+) within 48 hours after ROSC may be a predictive factor for recovery of neurological function at discharge in patients with ROSC from OHCA.