Elevated lactate is associated with mortality after cardiac arrest. Thiamine, a cofactor of pyruvate dehydrogenase, is necessary for aerobic metabolism. In a mouse model of cardiac arrest, thiamine improved pyruvate dehydrogenase activity, survival and neurologic outcome. To determine if thiamine would decrease lactate and increase oxygen consumption after in-hospital cardiac arrest. Randomized, double-blind, placebo-controlled phase II trial. Adult patients with arrest within 12 hours, mechanically ventilated, with lactate ≥ 3 mmol/L were included. Randomization was stratified by lactate > 5 or ≤ 5 mmol/L. Thiamine 500 mg or placebo was administered every 12 hours for 3 days. The primary outcome of lactate was checked at baseline, 6, 12, 24, and 48 hours, and compared using a linear mixed model, accounting for repeated measures. Secondary outcomes included oxygen consumption, pyruvate dehydrogenase, and mortality. Enrollments stopped after 36 patients due Data Safety and Monitoring Board concern about potential harm in an unplanned subgroup analysis. There was no overall difference in lactate (mean difference at 48 hours 1.5 mmol/L [95% CI −3.1–6.1], global p = 0.88) or any secondary outcomes. In those with randomization lactate > 5 mmol/L, mortality was 92% (11/12) with thiamine and 67% (8/12) with placebo (p = 0.32). In those with randomization lactate ≤ 5 mmol/L mortality was 17% (1/6) with thiamine and 67% (4/6) with placebo (p = 0.24). There was a significant interaction between randomization lactate and the effect of thiamine on survival (p = 0.03). In this single center trial thiamine had no overall effect on lactate after in-hospital cardiac arrest.

中文翻译：

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硫胺素作为院内心脏骤停后的代谢复苏剂

乳酸升高与心脏骤停后的死亡率相关。硫胺素是丙酮酸脱氢酶的辅助因子，是有氧代谢所必需的。在心脏骤停的小鼠模型中，硫胺素改善了丙酮酸脱氢酶活性、存活率和神经系统结果。确定硫胺素是否会在院内心脏骤停后降低乳酸并增加耗氧量。随机、双盲、安慰剂对照 II 期试验。纳入 12 小时内逮捕、机械通气、乳酸≥ 3 mmol/L 的成年患者。按乳酸 > 5 或 ≤ 5 mmol/L 进行随机分层。每 12 小时给予硫胺素 500 mg 或安慰剂，持续 3 天。在基线、6、12、24 和 48 小时检查乳酸的主要结果，并使用线性混合模型进行比较，考虑重复测量。次要结局包括耗氧量、丙酮酸脱氢酶和死亡率。由于数据安全和监测委员会担心计划外亚组分析中的潜在危害，在 36 名患者入组后停止了登记。乳酸没有总体差异（48 小时平均差异 1.5 mmol/L [95% CI -3.1–6.1]，总体 p = 0.88）或任何次要结果。在随机乳酸> 5 mmol/L的患者中，硫胺素组的死亡率为92% (11/12)，安慰剂组的死亡率为67% (8/12) (p = 0.32)。在随机分组乳酸≤ 5 mmol/L 的患者中，硫胺素组的死亡率为 17% (1/6)，安慰剂组的死亡率为 67% (4/6)（p = 0.24）。随机乳酸和硫胺素对生存的影响之间存在显着的相互作用（p = 0.03）。在这项单中心试验中，硫胺素对院内心脏骤停后的乳酸没有总体影响。