University of Oulu

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

Prognostic significance of arterial lactate levels at weaning from postcardiotomy venoarterial extracorporeal membrane oxygenation

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Author: Biancari, Fausto1,2; Fiore, Antonio3; Jónsson, Kristján4;
Organizations: 1Heart Center, Turku University Hospital and Department of Surgery, University of Turku, 20521 Turku, Finland
2Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, 90570 Oulu, Finland
3Department of Cardiothoracic Surgery, Henri Mondor University Hospital, AP-HP, Paris-Est University, 94000 Créteil, France
4Department of Cardiac Surgery, Sahlgrenska University Hospital, 41685 Gothenburg, Sweden
5Division of Cardiac Surgery, Ospedali Riuniti, 34121 Trieste, Italy
6Hamburg University Heart Center, 20246 Hamburg, Germany
7Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, 51100 Reims, France
8Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, 25000 Besançon, France
9Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, 35000 Rennes, France
10Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy
11Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy
12Cardiovascular Surgery, University Hospital of Duesseldorf, 40225 Dusseldorf, Germany
13Institute of Clinical and Experimental Medicine, 14021 Prague, Czech Republic
14Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow G814DY, UK
15Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium
16Department of Cardiothoracic Surgery, University of Lund, 22184 Lund, Sweden
17Prince Sultan Cardiac Center, Al Hassa 31982, Saudi Arabia
18Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester LE39QP, UK
19Department of Vascular Surgery, Nancy University Hospital, University of Lorraine, 54000 Nancy, France
20Department of Cardiothoracic Surgery, Münster University Hospital, 48149 Münster, Germany
21Department of Molecular Medicine and Surgery, Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, 171777 Stockholm, Sweden
22Heart and Lung Center, Helsinki University Hospital, 00290 Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, )
Persistent link: http://urn.fi/urn:nbn:fi-fe202002256426
Language: English
Published: Multidisciplinary Digital Publishing Institute, 2019
Publish Date: 2020-02-25
Description:

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.

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Series: Journal of clinical medicine
ISSN: 2077-0383
ISSN-E: 2077-0383
ISSN-L: 2077-0383
Volume: 8
Issue: 12
Article number: 2218
DOI: 10.3390/jcm8122218
OADOI: https://oadoi.org/10.3390/jcm8122218
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Subjects:
Copyright information: © 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/).
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