Lactate and lactate clearance as valuable tool to evaluate ECMO therapy in cardiogenic shock.

ECMO support is an ultimate ratio therapy for patients in refractory cardiogenic shock and is linked to high mortality. We assessed the dynamic characteristics of lactate during ECMO therapy and its predictive role on 30-day mortality. Data were retrospectively collected in all patients receiving ECMO support longer than 48h for cardiogenic shock from 01/2008 to 12/2016. Blood lactate was recorded before ECMO implantation, at prespecified timepoints during ECMO support, 1h and 6h post-ECMO as well as peak lactate during ECMO and peak within 24h after ECMO support. Statistical analysis included t-test and ROC-curves to identify cut-off levels for lactate levels to predict 30-day mortality. 139 patients underwent ECMO therapy longer than 48h for refractory cardiogenic shock resulting in a 30-day mortality of 68%. Lactate before ECMO and peak lactate level during ECMO support showed no significant connection to mortality, while lactate and lactate clearance at 24h were predictive for 30-day mortality with cut-off values of 2.15mmol/l and 0.687 respectively. Dynamic course of lactate during ECMO therapy is a valuable tool to assess effective circulatory support and is superior to single lactate measurements as a predictive marker for 30-day mortality.

Slottosch I ，Liakopoulos O ，Kuhn E ，Scherner M ，Deppe AC ，Sabashnikov A ，Mader N ，Choi YH ，Wippermann J ，Wahlers T ... -  《-》

Blood Lactate as a Reliable Marker for Mortality of Pediatric Refractory Cardiogenic Shock Requiring Extracorporeal Membrane Oxygenation.

Yang L ，Fan Y ，Lin R ，He W ... -  《-》

Does lactate clearance prognosticates outcomes in ECMO therapy: a retrospective observational study.

Mungan İ ，Kazancı D ，Bektaş Ş ，Ademoglu D ，Turan S ... -  《BMC Anesthesiology》

The early dynamic behavior of lactate is linked to mortality in postcardiotomy patients with extracorporeal membrane oxygenation support: A retrospective observational study.

Extracorporeal membrane oxygenation (ECMO) is used to support postcardiotomy cardiogenic shock patients. Elevated serum lactate levels might reflect hypoxia in the tissues, which is associated with mortality in critically ill patients. This study examined the association between the early dynamic behavior of lactate and mortality after ECMO support. We included 123 adult patients who had undergone cardiac surgery and received venous-arterial ECMO implantation to treat refractory postcardiotomy cardiogenic shock. The dynamic behaviors of lactate within 6 hours and 12 hours after the beginning of the ECMO support were incorporated into 2 regression models. A total of 56% of the patients were successfully weaned from ECMO support. The in-hospital mortality was 65.9% overall. Univariate and multivariate analyses indicated that age (odds ratio [OR]: 1.1 in the 6-hour model; 1.1 in the 12-hour model), gender (female; OR: 5.6 in the 6-hour model; 7.7 in the 12-hour model), mean lactate concentration (OR: 1.1 in the 6-hour model; 1.2 in the 12-hour model) and lactate clearance (OR: 0.5 in the 6-hour model; 0.1 in the 12-hour model) were reliable predictors (P < .05) of in-hospital mortality. The mean lactate concentration (C statistic: 0.71) and lactate clearance (C statistic: 0.72) 12 hours after the initiation of ECMO support provided better prognostic guidance. The mean lactate concentration (OR: 1.2) and lactate clearance (OR: 0.3) were able to predict successful weaning from ECMO in the 12-hour model only. In addition to age and gender (female), early lactate behaviors, particularly lactate clearance, after ECMO support are highly associated with in-hospital mortality in postcardiotomy patients. Additionally, early lactate behavior is also predictive of successful weaning from ECMO.

Li CL ，Wang H ，Jia M ，Ma N ，Meng X ，Hou XT ... -  《-》

Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study.

Scolari FL ，Schneider D ，Fogazzi DV ，Gus M ，Rover MM ，Bonatto MG ，de Araújo GN ，Zimerman A ，Sganzerla D ，Goldraich LA ，Teixeira C ，Friedman G ，Polanczyk CA ，Rohde LE ，Rosa RG ，Wainstein RV ... -  《BMC Cardiovascular Disorders》