Survival on Venoarterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock: Which Lactate Is Most Useful?
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
01 01 2022
01 01 2022
Historique:
pubmed:
27
3
2021
medline:
2
2
2022
entrez:
26
3
2021
Statut:
ppublish
Résumé
Prognostic significance of elevated serum lactate in patients on venoarterial extracorporeal membrane oxygenation (ECMO) is widely known. Our objective was to study the utility of lactate measured at different points of time and lactate clearance in predicting the two study endpoints: successful ECMO weaning and hospital survival. Among 238 consecutive patients treated with ECMO, lactic acid was collected before initiating ECMO and then on days 1, 3, 5, and 10 while on ECMO. Out of our cohort, 129 (54.2%) were successfully weaned and 98 (41.2%) were discharged alive. Patients successfully weaned from ECMO had a significantly lower lactic acid level pre-ECMO (p = 0.001), at day 1 (p < 0.001), day 3 (p < 0.001), and day 5 (p = 0.001), compared with unsuccessfully weaned patients. Also, patients who survived hospitalization had significantly lower lactic acid pre-ECMO (p = 0.007), at day 1 (p < 0.001), day 3 (p = 0.001), and day 5 (p = 0.001), compared with those who died in-hospital. With regard to hospital survival, day 3 lactic acid was superior to pre-ECMO lactic acid (p = 0.0385), lactic acid on day 1, lactic acid reduction from pre-ECMO to day 1 (p = 0.0177) and from pre-ECMO to day 3 (p = 0.0361), and a day 3 lactic acid ≤ 1.7 meq/L was the optimal value that predicted hospital survival. On multivariable analysis, day 3 lactic acid independently predicted hospital survival after covariate adjustment (odds ratio [OR], 0.505; 95% confidence interval [CI], 0.290-0.880; p = 0.016). In conclusion, the absolute level of lactic acid while on ECMO support is more important for prognosis than a pre-ECMO level or the magnitude of decline from pre-ECMO to on-ECMO.
Identifiants
pubmed: 33769350
doi: 10.1097/MAT.0000000000001413
pii: 00002480-202201000-00008
doi:
Substances chimiques
Lactic Acid
33X04XA5AT
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
41-45Informations de copyright
Copyright © ASAIO 2021.
Déclaration de conflit d'intérêts
Disclosure: The authors have no conflicts of interest to report.
Références
Levy B: Lactate and shock state: The metabolic view. Curr Opin Crit Care. 12: 315–321, 2006.
Vincent JL, Quintairos E Silva A, Couto L Jr, Taccone FS: The value of blood lactate kinetics in critically ill patients: A systematic review. Crit Care. 20: 257, 2016.
Fux T, Holm M, Corbascio M, Lund LH, van der Linden J: Venoarterial extracorporeal membrane oxygenation for postcardiotomy shock: Risk factors for mortality. J Thorac Cardiovasc Surg. 156: 1894–1902.e3, 2018.
Jung C, Janssen K, Kaluza M, et al.: Outcome predictors in cardiopulmonary resuscitation facilitated by extracorporeal membrane oxygenation. Clin Res Cardiol. 105: 196–205, 2016.
Mungan İ, Kazanci D, Bektaş Ş, Ademoglu D, Turan S: Does lactate clearance prognosticates outcomes in ECMO therapy: A retrospective observational study. BMC Anesthesiol. 18: 152, 2018.
Blumenstein J, Leick J, Liebetrau C, et al.: Extracorporeal life support in cardiovascular patients with observed refractory in-hospital cardiac arrest is associated with favourable short and long-term outcomes: A propensity-matched analysis. Eur Heart J Acute Cardiovasc Care. 5: 13–22, 2016.
Burrell AJ, Pellegrino VA, Wolfe R, et al.: Long-term survival of adults with cardiogenic shock after venoarterial extracorporeal membrane oxygenation. J Crit Care. 30: 949–956, 2015.
Dennis M, McCanny P, D’Souza M, et al.; Sydney ECMO Research Interest Group: Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: A multicentre experience. Int J Cardiol. 231: 131–136, 2017.
Flécher E, Anselmi A, Corbineau H, et al.: Current aspects of extracorporeal membrane oxygenation in a tertiary referral centre: Determinants of survival at follow-up. Eur J Cardiothorac Surg. 46: 665–671; discussion 671, 2014.
Carroll BJ, Shah RV, Murthy V, et al.: Clinical Features and outcomes in adults with cardiogenic shock supported by extracorporeal membrane oxygenation. Am J Cardiol. 116: 1624–1630, 2015.
Guenther SP, Brunner S, Born F, et al.: When all else fails: Extracorporeal life support in therapy-refractory cardiogenic shock. Eur J Cardiothorac Surg. 49: 802–809, 2016.
Slottosch I, Liakopoulos O, Kuhn E, et al.: Lactate and lactate clearance as valuable tool to evaluate ECMO therapy in cardiogenic shock. J Crit Care. 42: 35–41, 2017.
Formica F, Avalli L, Colagrande L, et al.: Extracorporeal membrane oxygenation to support adult patients with cardiac failure: Predictive factors of 30-day mortality. Interact Cardiovasc Thorac Surg. 10: 721–726, 2010.
Loforte A, Marinelli G, Musumeci F, et al.: Extracorporeal membrane oxygenation support in refractory cardiogenic shock: Treatment strategies and analysis of risk factors. Artif Organs. 38: E129–E141, 2014.
Li CL, Wang H, Jia M, Ma N, Meng X, Hou XT: The early dynamic behavior of lactate is linked to mortality in postcardiotomy patients with extracorporeal membrane oxygenation support: A retrospective observational study. J Thorac Cardiovasc Surg. 149: 1445–1450, 2015.