Can Blood Ammonia Level, Prehospital Time, and Return of Spontaneous Circulation Predict Neurological Outcomes of Out-of-Hospital Cardiac Arrest Patients? A Nationwide, Retrospective Cohort Study

Tsuyoshi Nojima, Hiromichi Naito, Takafumi Obara, Kohei Ageta, Hiromasa Yakushiji, Tetsuya Yumoto, Noritomo Fujisaki, Atsunori Nakao

Research output: Contribution to journalArticlepeer-review

Abstract

Background: This study aimed to test if blood ammonia levels at hospital arrival, considering prehospital time and the patient’s condition (whether return of spontaneous circulation [ROSC] was achieved at hospital arrival), can predict neurological outcomes after out-of-hospital cardiac arrest (OHCA). Methods: This was a retrospective cohort study on data from a nationwide OHCA registry in Japan. Patients over 17 years old and whose blood ammonia levels had been recorded were included. The primary outcome was favorable neurological outcome at 30 days after OHCA. Blood ammonia levels, prehospital time, and the combination of the two were evaluated using the receiver operating characteristic curve to predict favorable outcomes. Then, cut-off blood ammonia values were determined based on whether ROSC was achieved at hospital arrival. Results: Blood ammonia levels alone were sufficient to predict favorable outcomes. The overall cut-off ammonia value for favorable outcomes was 138 µg/dL; values were different for patients with ROSC (96.5 µg/dL) and those without ROSC (156 µg/dL) at hospital arrival. Conclusions: Our results using patient data from a large OHCA registry showed that blood ammonia levels at hospital arrival can predict neurological outcomes, with different cut-off values for patients with or without ROSC at hospital arrival.

Original languageEnglish
Article number2566
JournalJournal of Clinical Medicine
Volume11
Issue number9
DOIs
Publication statusPublished - May 1 2022

Keywords

  • ammonia
  • biomarkers
  • cardiopulmonary resuscitation
  • neurological outcome

ASJC Scopus subject areas

  • Medicine(all)

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