Department of Anesthesiology and Reanimation, Anadolu Medical Center, Kocaeli, Turkey.
Department of Cardiovascular Surgery, Anadolu Medical Center, Kocaeli, Turkey.
Braz J Cardiovasc Surg. 2024 Mar 1;39(2):e20230091. doi: 10.21470/1678-9741-2023-0091.
Findings of inadequate tissue perfusion might be used to predict the risk of mortality. In this study, we evaluated the effects of lactate and lactate clearance on mortality of patients who had undergone extracorporeal membrane oxygenation (ECMO).
Patients younger than 18 years old and who needed venoarterial ECMO support after surgery for congenital heart defects, from July 2010 to January 2019, were retrospectively analyzed. Patients successfully weaned from ECMO constituted Group 1, and patients who could not be weaned from ECMO were in Group 2. Postoperative clinics and follow-ups of the groups including mortality and discharge rates were evaluated.
There were 1,844 congenital heart surgeries during the study period, and 55 patients that required ECMO support were included in the study. There was no statistically significant difference between the groups regarding demographics and operative variables. The sixth-, 12th-, and 24th-hour lactate levels in Group 1 were statistically significantly lower than those in Group 2 (P=0.046, P=0.024, and P<0.001, respectively). There were statistically significant differences regarding lactate clearance between the groups at the 24th hour (P=0.009). The cutoff point for lactate level was found as ≥ 2.9, with 74.07% sensitivity and 78.57% specificity (P<0.001). The cutoff point for lactate clearance was determined as 69.44%, with 59.26% sensitivity and 78.57% specificity (P=0.003).
Prognostic predictive factors are important to initiate advanced treatment modalities in patients with ECMO support. In this condition, lactate and lactate clearance might be used as a predictive marker.
组织灌注不足的发现可能用于预测死亡率。在这项研究中，我们评估了乳酸和乳酸清除率对接受体外膜氧合（ECMO）治疗的患者死亡率的影响。
回顾性分析 2010 年 7 月至 2019 年 1 月期间因先天性心脏缺陷手术后需要静脉动脉 ECMO 支持的年龄小于 18 岁的患者。成功从 ECMO 脱机的患者构成组 1，无法从 ECMO 脱机的患者构成组 2。评估两组的术后临床情况和随访，包括死亡率和出院率。
研究期间共进行了 1844 例先天性心脏手术，55 例患者需要 ECMO 支持纳入研究。两组在人口统计学和手术变量方面无统计学差异。组 1 的第 6、12 和 24 小时乳酸水平明显低于组 2（P=0.046、P=0.024 和 P<0.001）。两组在第 24 小时的乳酸清除率存在统计学差异（P=0.009）。乳酸水平的截断值为≥2.9，灵敏度为 74.07%，特异性为 78.57%（P<0.001）。乳酸清除率的截断值为 69.44%，灵敏度为 59.26%，特异性为 78.57%（P=0.003）。
在为接受 ECMO 支持的患者启动高级治疗方案时，预后预测因素很重要。在这种情况下，乳酸和乳酸清除率可用作预测标志物。
