Department of Cardiothoracic Surgery, University Hospital Magdeburg, Magdeburg, Germany.
Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
J Crit Care. 2017 Dec;42:35-41. doi: 10.1016/j.jcrc.2017.06.022. Epub 2017 Jun 23.
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.
体外膜肺氧合（ECMO）支持是治疗难治性心源性休克患者的终极支持手段，与高死亡率相关。我们评估了 ECMO 治疗期间乳酸的动态特征及其对 30 天死亡率的预测作用。
回顾性收集了 2008 年 1 月至 2016 年 12 月期间因心源性休克接受 ECMO 支持时间超过 48 小时的所有患者的数据。记录 ECMO 植入前、ECMO 支持期间的预定时间点、ECMO 后 1 小时和 6 小时以及 ECMO 期间的峰值乳酸和 ECMO 支持后 24 小时内的峰值乳酸。统计分析包括 t 检验和 ROC 曲线，以确定乳酸水平的临界值，以预测 30 天死亡率。
139 例患者因难治性心源性休克接受 ECMO 治疗时间超过 48 小时，30 天死亡率为 68%。ECMO 前的乳酸和 ECMO 支持期间的峰值乳酸水平与死亡率无显著关联，而 24 小时的乳酸和乳酸清除率是 30 天死亡率的预测指标，其临界值分别为 2.15mmol/L 和 0.687。
ECMO 治疗期间乳酸的动态变化是评估有效循环支持的有用工具，优于单次乳酸测量作为 30 天死亡率的预测标志物。
