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

• Published in: The American journal of emergency medicine 2021-05, Vol.43, p.69-76
• Main Authors: Kong, Taeyoung, Chung, Yong Eun, Lee, Hye Sun, You, Je Sung, Chung, Hyun Soo, Park, Incheol, Chung, Sung Phil
• Format: Article
• Language: English
• Subjects: Acidosis; Alkalosis; Ambulance services; Cardiac arrest; Cardiovascular disease; Chloride; Chlorides; Clinical outcomes; Electrolytes; Emergency medical care; Heart; Heart attacks; Heart failure; Hospitals; Hyperchloremia; Hypothermia; Laboratories; Medical records; Metabolism; Mortality; Neurologic outcome; Observational studies; Out-of-hospital cardiac arrest; Patients; Physicians; Predictor; Targeted temperature management
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2021.01.027

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. 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. 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. 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.