Kurniawati E R, van Kuijk Smj, Vranken Npa, Maessen J G, Weerwind P W
Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.
Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, The Netherlands.
Clin Med Insights Circ Respir Pulm Med. 2022 Jul 21;16:11795484221113988. doi: 10.1177/11795484221113988. eCollection 2022.
This study aimed to describe the efficacy of veno-arterial extracorporeal life support (VA-ECLS) through early lactate clearance and pH restoration and assess the potential association with 30-day survival following hospital discharge.
Data of patients receiving VA-ECLS for at least 24 h were retrospectively compiled. Blood lactate levels, liver enzymes, and kidney parameters prior to VA-ECLS initiation and at 2, 8, 14, 20, and 26 h of support had been recorded as part of clinical care. The primary outcome was 30-day survival.
Of 77 patients who underwent VA-ECLS for refractory cardiogenic shock, 44.2% survived. For all non-survivors, ECLS was initiated after eight hours ( = .008). Blood pH was significantly higher in survivors compared to non-survivors at all time points except for pre-ECLS. Lactate levels were significantly lower in survivors (median range 1.95-4.70 vs 2.90-6.70 mmol/L for survivors vs non-survivors, respectively). Univariate and multivariate analyses indicated that blood pH at 24 h (OR 0.045, 95% CI: 0.005-0.448 for pH <7.35, = .045) and lactate concentration pre-ECLS (OR 0.743, 95% CI: 0.590-0.936, = .012) were reliable predictors for 30-day survival. Further, ischemic cardiogenic shock as ECLS indication showed 36.2% less lactate clearance compared to patients with other indications such as arrhythmia, postcardiotomy, and ECPR.
ECLS showed to be an effective treatment in reducing blood lactate levels in patients suffering from refractory cardiogenic shock in which the outcome is influenced by the initial lactate level and pH in the early phase of the intervention.
本研究旨在通过早期乳酸清除和pH值恢复来描述静脉-动脉体外膜肺氧合（VA-ECLS）的疗效，并评估其与出院后30天生存率的潜在关联。
回顾性收集接受VA-ECLS至少24小时的患者数据。作为临床护理的一部分，记录了VA-ECLS开始前以及支持2、8、14、20和26小时时的血乳酸水平、肝酶和肾脏参数。主要结局是30天生存率。
在77例因难治性心源性休克接受VA-ECLS的患者中，44.2%存活。所有未存活者在8小时后开始进行ECLS（P = 0.008）。除ECLS前外，在所有时间点，存活者的血pH值均显著高于未存活者。存活者的乳酸水平显著更低（存活者与未存活者的中位数范围分别为1.95 - 4.70 vs 2.90 - 6.70 mmol/L）。单因素和多因素分析表明，24小时时的血pH值（pH < 7.35时，OR = 0.045，95% CI：0.005 - 0.448，P = 0.045）和ECLS前的乳酸浓度（OR = 0.743，95% CI：0.590 - 0.936，P = 0.012）是30天生存率的可靠预测指标。此外，与因心律失常、心脏手术后和体外心肺复苏等其他适应症的患者相比，以缺血性心源性休克作为ECLS适应症的患者乳酸清除率低36.2%。
对于难治性心源性休克患者，ECLS在降低血乳酸水平方面显示出有效治疗作用，其中干预早期的初始乳酸水平和pH值会影响治疗结果。
