Prognostic significance of arterial lactate levels at weaning from postcardiotomy venoarterial extracorporeal membrane oxygenation
Biancari, Fausto; Fiore, Antonio; Jónsson, Kristján; Gatti, Giuseppe; Zipfel, Svante; Ruggieri, Vito G.; Perrotti, Andrea; Bounader, Karl; Loforte, Antonio; Lechiancole, Andrea; Saeed, Diyar; Lichtenberg, Artur; Pol, Marek; Spadaccio, Cristiano; Pettinari, Matteo; Mogianos, Krister; Alkhamees, Khalid; Mariscalco, Giovanni; El Dean, Zein; Settembre, Nicla; Welp, Henryk; Dell’Aquila, Angelo M.; Fux, Thomas; Juvonen, Tatu; Dalén, Magnus (2019-12-15)
Biancari, F.; Fiore, A.; Jónsson, K.; Gatti, G.; Zipfel, S.; Ruggieri, V.G.; Perrotti, A.; Bounader, K.; Loforte, A.; Lechiancole, A.; Saeed, D.; Lichtenberg, A.; Pol, M.; Spadaccio, C.; Pettinari, M.; Mogianos, K.; Alkhamees, K.; Mariscalco, G.; El Dean, Z.; Settembre, N.; Welp, H.; Dell’Aquila, A.M.; Fux, T.; Juvonen, T.; Dalén, M. Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation. J. Clin. Med. 2019, 8, 2218. https://doi.org/10.3390/jcm8122218
© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
https://creativecommons.org/licenses/by/4.0/
https://urn.fi/URN:NBN:fi-fe202002256426
Tiivistelmä
Abstract
Background: The outcome after weaning from postcardiotomy venoarterial extracorporeal membrane oxygenation (VA-ECMO) is poor. In this study, we investigated the prognostic impact of arterial lactate levels at the time of weaning from postcardiotomy VA. Methods: This analysis included 338 patients from the multicenter PC-ECMO registry with available data on arterial lactate levels at weaning from VA-ECMO. Results: Arterial lactate levels at weaning from VA-ECMO (adjusted OR 1.426, 95%CI 1.157–1.758) was an independent predictor of hospital mortality, and its best cutoff values was 1.6 mmol/L (<1.6 mmol/L, 26.2% vs. ≥ 1.6 mmol/L, 45.0%; adjusted OR 2.489, 95%CI 1.374–4.505). When 261 patients with arterial lactate at VA-ECMO weaning ≤2.0 mmol/L were analyzed, a cutoff of arterial lactate of 1.4 mmol/L for prediction of hospital mortality was identified (<1.4 mmol/L, 24.2% vs. ≥1.4 mmol/L, 38.5%, p = 0.014). Among 87 propensity score-matched pairs, hospital mortality was significantly higher in patients with arterial lactate ≥1.4 mmol/L (39.1% vs. 23.0%, p = 0.029) compared to those with lower arterial lactate. Conclusions: Increased arterial lactate levels at the time of weaning from postcardiotomy VA-ECMO increases significantly the risk of hospital mortality. Arterial lactate may be useful in guiding optimal timing of VA-ECMO weaning.
Kokoelmat
- Avoin saatavuus [31995]