Kim Eunchong, Sodirzhon-Ugli Nodirbek Yuldashev, Kim Do Wan, Lee Kyo Seon, Lim Yonghwan, Kim Min-Chul, Cho Yong Soo, Jung Yong Hun, Jeung Kyung Woon, Cho Hwa Jin, Jeong In Seok
Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea.
J Chest Surg. 2022 Apr 5;55(2):143-150. doi: 10.5090/jcs.21.127.
The effectiveness of extracorporeal membrane oxygenation (ECMO) for patients with refractory cardiogenic shock or cardiac arrest is being established, and serum lactate is well known as a biomarker of end-organ perfusion. We evaluated the efficacy of pre-ECMO lactate for predicting 6-month survival in patients with acute coronary syndrome (ACS) undergoing ECMO.
We reviewed the medical records of 148 patients who underwent veno-arterial (VA) ECMO for ACS between January 2015 and June 2020. These patients were divided into survivors and non-survivors based on 6-month survival. All clinical data before and during ECMO were compared between the 2 groups.
Patients' mean age was 66.0±10.5 years, and 116 (78.4%) were men. The total survival rate was 45.9% (n=68). Cox regression analysis showed that the pre-ECMO lactate level was an independent predictor of 6-month mortality (hazard ratio, 1.210; 95% confidence interval [CI], 1.064-1.376; p=0.004). The area under the receiver operating characteristic curve of pre-ECMO lactate was 0.64 (95% CI, 0.56-0.72; p=0.002; cut-off value=9.8 mmol/L). Kaplan-Meier survival analysis showed that the cumulative survival rate at 6 months was significantly higher among patients with a pre-ECMO lactate level of 9.8 mmol/L or less than among those with a level exceeding 9.8 mmol/L (57.3% vs. 31.8%, p=0.0008).
A pre-ECMO lactate of 9.8 mmol/L or less may predict a favorable outcome at 6 months in ACS patients undergoing VA-ECMO. Further research aiming to improve the accuracy of predictions of reversibility in patients with high pre-ECMO lactate levels is essential.
体外膜肺氧合（ECMO）治疗难治性心源性休克或心脏骤停患者的有效性正在得到确立，血清乳酸是公认的终末器官灌注生物标志物。我们评估了体外膜肺氧合（ECMO）前乳酸水平对接受ECMO的急性冠状动脉综合征（ACS）患者6个月生存率的预测效能。
我们回顾了2015年1月至2020年6月期间148例因急性冠状动脉综合征接受静脉-动脉（VA）ECMO治疗患者的病历。根据6个月生存率将这些患者分为生存者和非生存者。比较两组患者在ECMO前及ECMO期间的所有临床资料。
患者的平均年龄为66.0±10.5岁，116例（78.4%）为男性。总生存率为45.9%（n=68）。Cox回归分析显示，ECMO前乳酸水平是6个月死亡率的独立预测因素（风险比，1.210；95%置信区间[CI]，1.064-1.376；p=0.004）。ECMO前乳酸的受试者工作特征曲线下面积为0.64（95%CI，0.56-0.72；p=0.002；截断值=9.8 mmol/L）。Kaplan-Meier生存分析显示，ECMO前乳酸水平≤9.8 mmol/L的患者6个月累积生存率显著高于乳酸水平>9.8 mmol/L的患者（分别为57.3%和31.8%，p=0.0008）。
ECMO前乳酸水平≤9.8 mmol/L可能预示接受VA-ECMO的ACS患者6个月预后良好。进一步研究旨在提高ECMO前乳酸水平高的患者可逆性预测的准确性至关重要。
