Base excess and lactate as prognostic indicators for patients treated by extra corporeal life support after out hospital cardiac arrest due to acute coronary syndrome

Jouffroy, Romain; Lamhaut, Lionel; Guyard, A.; Phillipe, Pascal; Deluze, Thibaut; Jaffry, Murielle; Dagron, C.; Bourgoin, W.; Orsini, Jose; An, Ke; Jouven, Xavier; Spaulding, Christian; Carli, Pierre

doi:10.1016/j.resuscitation.2014.10.012

Cited by 32 publications

(13 citation statements)

References 27 publications

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“…Initial serum lactate level is correlated with prognosis in IHCA and OHCA treated with advanced CPR (27,28). Otherwise, Jouffroy et al (29) showed that lactate level greater than 10 mmol/L and base excess lesser than 12 mmol/L measured at the third hour in patients with OHCA managed by ECLS can predict the onset of multiple organ failure as well as death, thus making it possible to identify patients who would benefit from aggressive resuscitation. We found that initial levels of lactate and creatinine in the blood were independent predictors of mortality, highlighting quality of initial CPR and organ perfusion.…”

Section: Discussionmentioning

confidence: 99%

Comparable Outcome of Out‐of‐Hospital Cardiac Arrest and In‐Hospital Cardiac Arrest Treated With Extracorporeal Life Support

et al. 2017

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Extracorporeal life support (ECLS) has shown benefits in the management of refractory inhospital cardiac arrest (IHCA) by improving survival. Nonetheless, the results concerning out-of-hospital refractory cardiac arrests (OHCA) remain uncertain. The aim of our investigation was to compare survival between the two groups. We realized a single-center retrospective, observational study of all patients who presented IHCA or OHCA treated with ECLS between 2011 and 2015. Multivariate analysis was realized to determine independent factors associated with mortality. Over the 4-year period, 65 patients were included, 43 in the IHCA group (66.2%), and 22 (33.8%) in the OHCA group. The duration of low flow was significantly longer in the OHCA group (60 vs. 90 min, P 5 0.004). Survival to discharge from the hospital was identical in the two groups (27% in the OHCA group vs. 23% in the IHCA group, P 5 0.77). All surviving patients in the OHCA group had a cerebral performance categories score of 1-2. In multivariate analysis, we found that the initial lactate level and baseline blood creatinine were independently associated with mortality. We found comparable survival and neurological score in patients who presented IHCA and OHCA treated with ECLS. We believe that appropriate selection of patients and optimization of organ perfusion during resuscitation can lead to good results in patients with OHCA treated with ECLS. Key Words: Extracorporeal life support-Cardiac arrestCardiopulmonary resuscitation.Conventional management of cardiac arrest (CA) has evolved considerably in recent years, nevertheless mortality is still high (1,2). This is essentially related to the neurological prognosis and thus to cerebral damage due to ischemia and reperfusion injury. Given this, the management of CA should focus on maintaining effective circulation during the external cardiac massage and to manage adequately the return to spontaneous circulation.The use of extracorporeal life support (ECLS) for the management of in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) has been widely described (3). Nonetheless, doubts have been expressed about the usefulness of ECLS in OHCA (4). Indeed, rapid ECLS implementation is a major concern. However, in large towns with heavy traffic, timely implementation of ECLS and restoration of effective circulation is sometimes very long.To update our management practices and to determine the usefulness of ECLS in OHCA, we conducted a retrospective study of all IHCA and OHCA treated with ECLS to compare survival and the neurological prognosis of our patients.

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Section: Discussionmentioning

confidence: 99%

Comparable Outcome of Out‐of‐Hospital Cardiac Arrest and In‐Hospital Cardiac Arrest Treated With Extracorporeal Life Support

et al. 2017

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“…The impact of oxygenation and positive influence on outcomes has been shown in several studies. [ 14 15 16 ]…”

Section: Discussionmentioning

confidence: 99%

Outcomes of implementation of enhanced goal directed therapy in high-risk patients undergoing abdominal surgery

2015

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Background and Aims:Advanced monitoring targeting haemodynamic and oxygenation variables can improve outcomes of surgery in high-risk patients. We aimed to assess the impact of goal directed therapy (GDT) targeting cardiac index (CI) and oxygen extraction ratio (O2ER) on outcomes of high-risk patients undergoing abdominal surgery.Methods:In a prospective randomised trial, forty patients (American Society of Anaesthesiologists II and III) undergoing major abdominal surgeries were randomised into two groups. In-Group A mean arterial pressure ≥ 65 mmHg, central venous pressure ≥ 8–10 mmHg, urine output ≥ 0.5 mL/kg/h and central venous oxygen saturation ≥ 70% were targeted intra-operatively and 12 h postoperatively. In-Group-B (enhanced GDT), in addition to the monitoring in-Group-A, CI ≥ 2.5 L/min/m2 and O2ER ≤ 27% were targeted. The end-points were lactate levels and base deficit during and after surgery. The secondary end points were length of Intensive Care Unit (ICU) and hospital stay and postoperative complications. Wilcoxon Mann Whitney and Chi-square tests were used for statistical assessment.Results:Lactate levels postoperatively at 4 and 8 h were lower in-Group-B (P < 0.05). The mean base deficit at 3, 4, 5 and 6 h intra-operatively and postoperatively after 4, 8 and 12 h were lower in-Group-B (P < 0.05). There were no significant differences in ICU stay (2.10 ± 1.52 vs. 2.90 ± 2.51 days) or hospital stay (10.85 + 4.39 vs. 13.35 + 6.77 days) between Group A and B.Conclusions:Implementation of enhanced GDT targeting CI and OER was associated with improved tissue oxygenation.

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“…without circulatory assist device) established a predictive link between survival and initial lactate levels and reported serum lactate as an independent prognostic factor of mortality and neurological outcome [23,24]. Moreover, recent retrospective studies [19,[24][25][26][27] (the largest including 117 refractory CA [26]) revealed serum lactate as a potent predictor of outcome for patients treated with ECLS. Additionally, even if changes in lactate take place more slowly than changes in systemic arterial pressure or cardiac output, lactate levels decrease over a period of hours with effective therapy [20].…”

Section: Discussionmentioning

confidence: 99%

Blood lactate predicts survival after percutaneous implantation of extracorporeal life support for refractory cardiac arrest or cardiogenic shock complicating acute coronary syndrome: insights from the CareGem registry

et al. 2020

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Refractory cardiogenic shock (RCS) or refractory cardiac arrest (RCA) complicating acute coronary syndrome (ACS) is associated with extremely high mortality rate. Veno-arterial extracorporeal life support (VA-ECLS) represents a valuable therapeutic option to stabilize patients' condition before or at the time of emergency revascularization. We analyzed 29 consecutive patients with RCS or RCA complicating ACS, and implanted with VA-ECLS in two centers who have adopted a similar, structured approach to ECLS implantation. Data were collected from January 2010 to December 2015 and ECLS had to be percutaneously implanted either before (within 48 h) or at the time of attempted percutaneous coronary revascularization (PCI). We investigated in-hospital outcome and factors associated with survival. Twenty-one (72%) were implanted for RCA, whereas 8 (28%) were implanted on ECLS for RCS. All RCA were witnessed and no-flow time was shorter than 5 min in all cases but one. All patients underwent attempted emergency PCI, using radial access in ten cases (34.5%), whereas in three patients a subsequent CABG was performed. Overall, ten patients (34.5%) survived, nine of them with a good neurological outcome. Life threatening complications, including stroke (4 pts), leg ischemia (4 pts), intestinal ischemia (5 pts), and deep vein thrombosis 2 pts), occurred frequently, but were not associated with in-hospital death. Main cause of death was multiorgan failure. PCI variables did not predict survival. Survivors were younger, with shorter low-flow time, and with ECLS mainly implanted for RCS. At multivariate analysis, levels of lactate at ECLS implantation (OR 4.32, 95%CI 1.01-18.51, p = 0.049) emerged as the only variable that independently predicted survival. In patients with RCA or RCS complicating ACS who are percutaneously implanted with ECLS before or at the time of coronary revascularization, in hospital survival rate is higher than 30%. Level of lactate at ECLS implantation appears to be the most important factor to predict survival.

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Base excess and lactate as prognostic indicators for patients treated by extra corporeal life support after out hospital cardiac arrest due to acute coronary syndrome

Cited by 32 publications

References 27 publications

Comparable Outcome of Out‐of‐Hospital Cardiac Arrest and In‐Hospital Cardiac Arrest Treated With Extracorporeal Life Support

Comparable Outcome of Out‐of‐Hospital Cardiac Arrest and In‐Hospital Cardiac Arrest Treated With Extracorporeal Life Support

Outcomes of implementation of enhanced goal directed therapy in high-risk patients undergoing abdominal surgery

Blood lactate predicts survival after percutaneous implantation of extracorporeal life support for refractory cardiac arrest or cardiogenic shock complicating acute coronary syndrome: insights from the CareGem registry

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