Division of Critical Care, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Pediatrics, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Pediatr Neonatol. 2022 Sep;63(5):474-483. doi: 10.1016/j.pedneo.2022.03.011. Epub 2022 May 21.
This study aims to compare lactate and central venous blood gas in the prediction of outcome in pediatric venoarterial mode extracorporeal membrane oxygenation (V-A ECMO).
This was a retrospective observational study conducted on patients undergoing V-A ECMO care in the pediatric intensive care unit of a tertiary medical center in Taiwan. Patients under 18 years of age undergoing V-A ECMO from January 2009 to April 2019 were included in this study.
This study consisted of 47 children who received V-A ECMO with an overall weaning rate of 66.0%. The mean age was 5.5 years and mean ECMO duration was 11.6 days. Successful weaning group had significantly lower lactate levels at initial (58.7 ± 47.0 mg/dL vs. 108.0 ± 55.3 mg/dL, p = 0.003), 0-12 h (37.8 ± 29.0 mg/dL vs. 83.5 ± 60.0 mg/dL, p Z 0.001), and 12-24 h (29.4 ± 26.9 mg/dL vs. 69.1 ± 59.1 mg/dL, p = 0.003) after ECMO initiation; however, the central venous blood gas including pH, HCO, CO, base excess (BE), and O saturation showed no significant difference. The favorable outcome group had significantly lower lactate levels at 0-12 h (32.8 ± 26.3 mg/dL vs. 71.3 ± 53.3 mg/dL, p = 0.005), and 12-24 h (20.7 ± 10.2 mg/dL vs. 61.9 ± 53.5 mg/dL, p = 0.002); however, the HCO levels (26.2 ± 4.5 mmol/L vs. 22.9 ± 6.8 mmol/L, p = 0.042) and BE (2.2 ± 5.4 vs. 2.2 ± 8.5, p = 0.047) were significantly higher at 12-24 h. In multivariate logistic regression, 12-24 h lactate value was an independent factor for unfavorable outcomes (p = 0.015, odds ratio [OR] = 1.1) with the best cut-off value of 48.6 mg/dL (sensitivity 48%, specificity 100%).
Lactate has better outcome prediction than central venous blood gas in pediatric V-A ECMO. The lactate value 12-24 h after ECMO initiation was an independent factor for unfavorable outcomes.
本研究旨在比较乳酸和中心静脉血气在儿科静脉-动脉体外膜肺氧合（V-A ECMO）中的预后预测。
这是一项在台湾一家三级医疗中心的儿科重症监护病房接受 V-A ECMO 治疗的患者中进行的回顾性观察性研究。纳入 2009 年 1 月至 2019 年 4 月期间接受 V-A ECMO 的 18 岁以下患者。
本研究包括 47 名接受 V-A ECMO 的患儿，总体撤机率为 66.0%。平均年龄为 5.5 岁，平均 ECMO 持续时间为 11.6 天。成功撤机组在 ECMO 启动时初始（58.7 ± 47.0 mg/dL 比 108.0 ± 55.3 mg/dL，p = 0.003）、0-12 小时（37.8 ± 29.0 mg/dL 比 83.5 ± 60.0 mg/dL，p Z 0.001）和 12-24 小时（29.4 ± 26.9 mg/dL 比 69.1 ± 59.1 mg/dL，p = 0.003）时的乳酸水平显著降低；然而，中心静脉血气包括 pH、HCO、CO、碱剩余（BE）和 O 饱和度无显著差异。预后良好组在 0-12 小时（32.8 ± 26.3 mg/dL 比 71.3 ± 53.3 mg/dL，p = 0.005）和 12-24 小时（20.7 ± 10.2 mg/dL 比 61.9 ± 53.5 mg/dL，p = 0.002）时的乳酸水平显著降低；然而，HCO 水平（26.2 ± 4.5 mmol/L 比 22.9 ± 6.8 mmol/L，p = 0.042）和 BE（2.2 ± 5.4 比 2.2 ± 8.5，p = 0.047）在 12-24 小时时显著升高。在多变量逻辑回归中，12-24 小时乳酸值是不良结局的独立因素（p = 0.015，优势比[OR] = 1.1），最佳截断值为 48.6 mg/dL（灵敏度 48%，特异性 100%）。
乳酸在儿科 V-A ECMO 中的预后预测优于中心静脉血气。ECMO 启动后 12-24 小时的乳酸值是不良结局的独立因素。
