From the Internal Medicine Physician at Online Care Group, Chicago, Illinois.
University of Kentucky College of Medicine, Lexington, Kentucky.
ASAIO J. 2022 Jan 1;68(1):41-45. doi: 10.1097/MAT.0000000000001413.
Prognostic significance of elevated serum lactate in patients on venoarterial extracorporeal membrane oxygenation (ECMO) is widely known. Our objective was to study the utility of lactate measured at different points of time and lactate clearance in predicting the two study endpoints: successful ECMO weaning and hospital survival. Among 238 consecutive patients treated with ECMO, lactic acid was collected before initiating ECMO and then on days 1, 3, 5, and 10 while on ECMO. Out of our cohort, 129 (54.2%) were successfully weaned and 98 (41.2%) were discharged alive. Patients successfully weaned from ECMO had a significantly lower lactic acid level pre-ECMO (p = 0.001), at day 1 (p < 0.001), day 3 (p < 0.001), and day 5 (p = 0.001), compared with unsuccessfully weaned patients. Also, patients who survived hospitalization had significantly lower lactic acid pre-ECMO (p = 0.007), at day 1 (p < 0.001), day 3 (p = 0.001), and day 5 (p = 0.001), compared with those who died in-hospital. With regard to hospital survival, day 3 lactic acid was superior to pre-ECMO lactic acid (p = 0.0385), lactic acid on day 1, lactic acid reduction from pre-ECMO to day 1 (p = 0.0177) and from pre-ECMO to day 3 (p = 0.0361), and a day 3 lactic acid ≤ 1.7 meq/L was the optimal value that predicted hospital survival. On multivariable analysis, day 3 lactic acid independently predicted hospital survival after covariate adjustment (odds ratio [OR], 0.505; 95% confidence interval [CI], 0.290-0.880; p = 0.016). In conclusion, the absolute level of lactic acid while on ECMO support is more important for prognosis than a pre-ECMO level or the magnitude of decline from pre-ECMO to on-ECMO.
动静脉体外膜肺氧合（ECMO）患者血清乳酸升高的预后意义已广为人知。我们的目的是研究不同时间点测量的乳酸和乳酸清除率在预测两个研究终点（ECMO 成功脱机和医院存活）中的效用。在 238 例连续接受 ECMO 治疗的患者中，在启动 ECMO 前采集乳酸，然后在 ECMO 期间的第 1、3、5 和 10 天采集。在我们的队列中，129 例（54.2%）成功脱机，98 例（41.2%）出院存活。与未成功脱机的患者相比，成功脱机的患者 ECMO 前乳酸水平（p = 0.001）、第 1 天（p < 0.001）、第 3 天（p < 0.001）和第 5 天（p = 0.001）明显较低。此外，存活出院的患者 ECMO 前乳酸水平（p = 0.007）、第 1 天（p < 0.001）、第 3 天（p = 0.001）和第 5 天（p = 0.001）明显低于住院期间死亡的患者。关于医院存活率，第 3 天乳酸优于 ECMO 前乳酸（p = 0.0385），第 1 天乳酸、ECMO 前至第 1 天乳酸下降（p = 0.0177）和 ECMO 前至第 3 天乳酸下降（p = 0.0361），第 3 天乳酸≤1.7 meq/L 是预测医院存活率的最佳值。多变量分析显示，调整协变量后，第 3 天乳酸独立预测医院存活率（比值比[OR]，0.505；95%置信区间[CI]，0.290-0.880；p = 0.016）。总之，ECMO 支持时乳酸的绝对水平对预后比 ECMO 前水平或从 ECMO 前到 ECMO 期间的下降幅度更重要。
