Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation
: Fausto Biancari, Antonio Fiore, Kristján Jónsson, Giuseppe Gatti, Svante Zipfel, Vito G. Ruggieri, Andrea Perrotti, Karl Bounader, Antonio Loforte, Andrea Lechiancole, Diyar Saeed, Artur Lichtenberg, Marek Pol, Cristiano Spadaccio, Matteo Pettinari, Krister Mogianos, Khalid Alkhamees, Giovanni Mariscalco,
Zein El Dean, Nicla Settembre, Henryk Welp, Angelo M. Dell’Aquila, Thomas Fux, Tatu Juvonen, Magnus Dalén
Publisher: MDPI
: 2019
Journal of Clinical Medicine
: JOURNAL OF CLINICAL MEDICINE
: J CLIN MED
: ARTN 2218
: 8
: 12
: 10
: 2077-0383
DOI: https://doi.org/10.3390/jcm8122218
: https://www.mdpi.com/2077-0383/8/12/2218
: https://research.utu.fi/converis/portal/detail/Publication/45348408
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.
