Department of Anesthesiology and Intensive Care, John Paul II Hospital, 31-202 Krakow, Poland.
Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland.
Int J Environ Res Public Health. 2021 Sep 16;18(18):9764. doi: 10.3390/ijerph18189764.
While ECLS is a highly invasive procedure, the identification of patients with a potentially good prognosis is of high importance. The aim of this study was to analyse changes in the acid-base balance parameters and lactate kinetics during the early stages of ECLS rewarming to determine predictors of clinical outcome.
This single-centre retrospective study was conducted at the Severe Hypothermia Treatment Centre at John Paul II Hospital in Krakow, Poland. Patients ≥18 years old who had a core temperature (Tc) < 30 °C and were rewarmed with ECLS between December 2013 and August 2018 were included. Acid-base balance parameters were measured at ECLS implantation, at Tc 30 °C, and at 2 and 4 h after Tc 30 °C. The alteration in blood lactate kinetics was calculated as the percent change in serum lactate concentration relative to the baseline.
We included 50 patients, of which 36 (72%) were in cardiac arrest. The mean age was 56 ± 15 years old, and the mean Tc was 24.5 ± 12.6 °C. Twenty-one patients (42%) died. Lactate concentrations in the survivors group were significantly lower than in the non-survivors at all time points. In the survivors group, the mean lactate concentration decreased -2.42 ± 4.49 mmol/L from time of ECLS implantation until 4 h after reaching Tc 30 °C, while in the non-survivors' group ( = 0.024), it increased 1.44 ± 6.41 mmol/L.
Our results indicate that high lactate concentration is associated with a poor prognosis for hypothermic patients undergoing ECLS rewarming. A decreased value of lactate kinetics at 4 h after reaching 30 °C is also associated with a poor prognosis.
虽然体外膜肺氧合（ECLS）是一种高度侵入性的程序，但识别具有良好预后潜力的患者非常重要。本研究的目的是分析 ECLS 复温早期酸碱平衡参数和乳酸动力学的变化，以确定临床结局的预测因素。
这是一项在波兰克拉科夫约翰保罗二世医院重度低体温治疗中心进行的单中心回顾性研究。纳入年龄≥18 岁、核心温度（Tc）<30°C 并在 2013 年 12 月至 2018 年 8 月期间使用 ECLS 复温的患者。在 ECLS 植入时、Tc 达到 30°C 时以及 Tc 达到 30°C 后 2 和 4 小时测量酸碱平衡参数。通过血清乳酸浓度相对于基线的变化百分比计算血液乳酸动力学的变化。
我们纳入了 50 名患者，其中 36 名（72%）发生了心脏骤停。平均年龄为 56±15 岁，平均 Tc 为 24.5±12.6°C。21 名患者（42%）死亡。存活组的乳酸浓度在所有时间点均明显低于非存活组。在存活组中，从 ECLS 植入到达到 Tc 30°C 后 4 小时，乳酸浓度平均下降了-2.42±4.49mmol/L，而非存活组（=0.024）增加了 1.44±6.41mmol/L。
我们的结果表明，高乳酸浓度与接受 ECLS 复温的低体温患者的预后不良相关。达到 30°C 后 4 小时乳酸动力学值降低也与预后不良相关。
