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Biancari F, Fiore A, Jónsson K, et al. Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation. J Clin Med. 2019;8(12)doi: 10.3390/jcm8122218.
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. (2019). Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation. Journal of clinical medicine, 8(12), . https://doi.org/10.3390/jcm8122218
Biancari, Fausto, et al. "Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation." Journal of clinical medicine vol. 8,12 (2019). doi: https://doi.org/10.3390/jcm8122218
Biancari F, Fiore A, Jónsson K, Gatti G, Zipfel S, Ruggieri VG, 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 AM, Fux T, Juvonen T, Dalén M. Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation. J Clin Med. 2019 Dec 15;8(12). doi: 10.3390/jcm8122218. PMID: 31847464; PMCID: PMC6947236.
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J Clin Med. 2019 Dec 15;8(12). doi: 10.3390/jcm8122218.

Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation.

Journal of clinical medicine

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

Affiliations

  1. Heart Center, Turku University Hospital and Department of Surgery, University of Turku, 20521 Turku, Finland.
  2. Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, 90570 Oulu, Finland.
  3. Department of Cardiothoracic Surgery, Henri Mondor University Hospital, AP-HP, Paris-Est University, 94000 Créteil, France.
  4. Department of Cardiac Surgery, Sahlgrenska University Hospital, 41685 Gothenburg, Sweden.
  5. Division of Cardiac Surgery, Ospedali Riuniti, 34121 Trieste, Italy.
  6. Hamburg University Heart Center, 20246 Hamburg, Germany.
  7. Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, 51100 Reims, France.
  8. Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, 25000 Besançon, France.
  9. Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, 35000 Rennes, France.
  10. Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
  11. Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy.
  12. Cardiovascular Surgery, University Hospital of Duesseldorf, 40225 Dusseldorf, Germany.
  13. Institute of Clinical and Experimental Medicine, 14021 Prague, Czech Republic.
  14. Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow G814DY, UK.
  15. Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium.
  16. Department of Cardiothoracic Surgery, University of Lund, 22184 Lund, Sweden.
  17. Prince Sultan Cardiac Center, Al Hassa 31982, Saudi Arabia.
  18. Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester LE39QP, UK.
  19. Department of Vascular Surgery, Nancy University Hospital, University of Lorraine, 54000 Nancy, France.
  20. Department of Cardiothoracic Surgery, Münster University Hospital, 48149 Münster, Germany.
  21. Department of Molecular Medicine and Surgery, Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, 171777 Stockholm, Sweden.
  22. Heart and Lung Center, Helsinki University Hospital, 00290 Helsinki, Finland.

PMID: 31847464 PMCID: PMC6947236 DOI: 10.3390/jcm8122218

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%,

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.

Keywords: ECMO; VA-ECMO; cardiac surgery; extracorporeal membrane oxygenation; postcardiotomy; venoarterial

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