Acute cardiac care & resuscitation
The Absolute Lactate Levels Versus Clearance for Prognostication of Post-Cardiotomy Patients on Veno-Arterial ECMO
Authors' conclusion
Serial measurements of arterial blood lactate and LC help in obtaining early prognostic guidance in adult patients supported by VA-ECMO after cardiac surgery. Absolute lactate levels, compared with LC at the same time points, demonstrated better performance in differentiating mortality.
Study context
- Population
- Adults receiving post-cardiotomy veno-arterial extracorporeal membrane oxygenation (VA-ECMO), 2016–2022of 2368 cardiac surgery patients
- Participants
- 152 adults
- Exposure
- Absolute lactate levels vs lactate clearance for prognosis
- Survivorsn = 48reference
- Non-survivorsn = 104
- Outcome
- In-hospital mortality
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
- Lactate at 12 h (>8.2 mmol/L) AUROC
- 0.868
- Lactate at 24 h (>2.6 mmol/L) AUROC
- 0.896
- LC-T12 (<21.94%) AUROC
- 0.807
- LC-T24 (<40.3%) AUROC
- 0.839
- Peak lactate (>14.35 mmol/L) AUROC
- 0.828
- Initial pre-ECMO lactate (>6.25 mmol/L) AUROC
- 0.731
Observational data: associations, not effects.
Further findings
Mortality by lactate clearance (LC) (Cox regression)
| Adjusted HR (95% CI) | P value | ||
|---|---|---|---|
| LC <21.94% at T12 h | 2.73 (1.64–5.762) | P < 0.001 | |
| LC <40.3% at T24 h | 1.98 (1.46–4.173) | P < 0.001 | |
| 0.20.5125Adjusted hazard ratio (log scale) |
Predictors of hospital mortality
| OR (95% CI) | P value | ||
|---|---|---|---|
| Lactate at 12 h | 1.67 (1.121–2.181) | P = 0.001 | |
| Initial SOFA score | 1.593 (1.15–2.73) | P < 0.001 | |
| Initial blood lactate | 1.21 (1.016–1.721) | P = 0.032 | |
| AF | 6.17 (2.37–57.214) | P = 0.003 | |
| 0.050.21520Odds ratio (log scale) |
- Mortality by LC (Cox regression) — Kaplan-Meier: LC <21.94% at T12 h and <40.3% at T24 h associated with decreased survival
- log-rank P < 0.001
Baseline characteristics, non-survivors vs survivors
- AF 41.35% vs 12.5%
- P < 0.001
- CKD 26.9% vs 6.3%
- P = 0.004
- Cardiopulmonary bypass time 237 vs 192 min
- P = 0.016
- Aortic cross-clamping time 160 vs 124 min
- P = 0.04
- Median Sequential Organ Failure Assessment (SOFA) score at ECMO initiation 13.5 vs 9
- P < 0.001
- Median SAVE score −3 vs 3
- P < 0.001
Correlation of lactate with LC
- 12 h, survivors r = −0.755
- P < 0.001
- 12 h, non-survivors r = −0.601
- P < 0.001
- 24 h, survivors r = −0.764
- P < 0.001
- 24 h, non-survivors r = −0.847
- P < 0.001
Original publication
The Absolute Lactate Levels Versus Clearance for Prognostication of Post-Cardiotomy Patients on Veno-Arterial ECMO. ESC Heart Fail. Published 9 July 2024. doi:10.
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