Hyperlactatemia and poor outcome After postcardiotomy veno-arterial extracorporeal membrane oxygenation: An individual patient data meta-Analysis.

Autor:	Biancari F; Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.; Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland., Kaserer A; Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland., Perrotti A; Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France., Ruggieri VG; Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France., Cho SM; Departments of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA., Kang JK; Departments of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA., Dalén M; Department of Molecular Medicine and Surgery, and Cardiac Surgery, Karolinska Institutet, Stockholm, Sweden., Welp H; Department of Cardiothoracic Surgery, Münster University Hospital, Münster, Germany., Jónsson K; Department of Cardiac Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden., Ragnarsson S; Department of Cardiothoracic Surgery, University of Lund, Lund, Sweden., Hernández Pérez FJ; Puerta de Hierro University Hospital, Madrid, Spain., Gatti G; Cardio-Thoracic and Vascular Department, University Hospital of Trieste, Trieste, Italy., Alkhamees K; Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia., Loforte A; Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna, Italy., Lechiancole A; Cardiothoracic Department, University Hospital of Udine, Udine, Italy., Rosato S; Center for Global Health, Italian National Institute, Rome, Italy., Spadaccio C; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA., Pettinari M; Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium., Mariscalco G; Department of Intensive Care Medicine and Cardiac Surgery, Glenfield Hospital, Leicester, UK., Mäkikallio T; Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland., Sahli SD; Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland., L'Acqua C; Anesthesia and Intensive Care Unit, Centro Cardiologico Monzino, Italy.; Anesthesia and Intensive Care Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Italy., Arafat AA; Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.; Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt., Albabtain MA; Cardiology Clinical Pharmacy, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia., AlBarak MM; Intensive Care Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia., Laimoud M; Cardiac Surgical Intensive Care Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.; Critical Care Medicine Department, Cairo University, Cairo, Egypt., Djordjevic I; Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany., Krasivskyi I; Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany., Samalavicius R; 2nd Department of Anesthesia, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.; Clinic of Emergency Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania., Puodziukaite L; 2nd Department of Anesthesia, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania., Alonso-Fernandez-Gatta M; Cardiology Department, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain.; CIBER-CV Instituto de Salud Carlos III, Madrid, Spain., Spahn DR; Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland., Fiore A; Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Creteil, France.
Jazyk:	angličtina
Zdroj:	Perfusion [Perfusion] 2024 Jul; Vol. 39 (5), pp. 956-965. Date of Electronic Publication: 2023 Apr 17.
DOI:	10.1177/02676591231170978
Abstrakt:	Introduction: Postcardiotomy veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) is associated with significant mortality. Identification of patients at very high risk for death is elusive and the decision to initiate V-A-ECMO is based on clinical judgment. The prognostic impact of pre-V-A-ECMO arterial lactate level in these critically ill patients has been herein evaluated. Methods: A systematic review was conducted to identify studies on postcardiotomy VA-ECMO for the present individual patient data meta-analysis. Results: Overall, 1269 patients selected from 10 studies were included in this analysis. Arterial lactate level at V-A-ECMO initiation was increased in patients who died during the index hospitalization compared to those who survived (9.3 vs 6.6 mmol/L, p < 0.0001). Accordingly, in hospital mortality increased along quintiles of pre-V-A-ECMO arterial lactate level (quintiles: 1, 54.9%; 2, 54.9%; 3, 67.3%; 4, 74.2%; 5, 82.2%, p < 0.0001). The best cut-off for arterial lactate was 6.8 mmol/L (in-hospital mortality, 76.7% vs. 55.7%, p < 0.0001). Multivariable multilevel mixed-effect logistic regression model including arterial lactate level significantly increased the area under the receiver operating characteristics curve (0.731, 95% CI 0.702-0.760 vs 0.679, 95% CI 0.648-0.711, DeLong test p < 0.0001). Classification and regression tree analysis showed the in-hospital mortality was 85.2% in patients aged more than 70 years with pre-V-A-ECMO arterial lactate level ≥6.8 mmol/L. Conclusions: Among patients requiring postcardiotomy V-A-ECMO, hyperlactatemia was associated with a marked increase of in-hospital mortality. Arterial lactate may be useful in guiding the decision-making process and the timing of initiation of postcardiotomy V-A-ECMO. Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu