Blood lactate level during extracorporeal life support as a surrogate marker for survival

Park, Sung Jun; Kim, Sang-Pil; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won

doi:10.1016/j.jtcvs.2014.02.078

Cited by 59 publications

(48 citation statements)

References 19 publications

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“…For ALT, a cutoff of 4‐fold of the upper limit of normal has been adopted by Fondevila et al, whereas Savier et al have defined this limit at 200 IU/L . Although serum lactate is considered to be a marker of adequate perfusion and hepatic clearance, these groups have placed little importance on this factor, probably because its concentration during NRP may be altered by reflux from extra‐abdominal regions . Recent studies on normothermic machine perfusion have used serum lactate levels for ex situ evaluation .…”

Section: Discussioncontrasting

confidence: 60%

“…(8,9) Although serum lactate is considered to be a marker of adequate perfusion and hepatic clearance, these groups have placed little importance on this factor, probably because its concentration during NRP may be altered by reflux from extra-abdominal regions. (8,9,31) Recent studies on normothermic machine perfusion have used serum lactate levels for ex situ evaluation. (32)(33)(34) In our study, although levels exceeded the above-mentioned limits, ALT did not exhibit a clear relationship to the transplant outcomes.…”

Section: Original Article | 1533mentioning

confidence: 99%

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Liver Grafts From Donors After Circulatory Death on Regional Perfusion With Extended Warm Ischemia Compared With Donors After Brain Death

et al. 2018

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Donation after circulatory death (DCD) in Italy constitutes a relatively unique population because of the requirement of a no-touch period of 20 minutes. The first aim of this study was to compare liver transplantations from donors who were maintained on normothermic regional perfusion after circulatory death and suffered extended warm ischemia (DCD group, n = 20) with those from donors who were maintained on extracorporeal membrane oxygenation (ECMO) and succumbed to brain death (ECMO group, n = 17) and those from standard donors after brain death (donation after brain death [DBD] group, n = 52). Second, we conducted an explorative analysis on the DCD group to identify relationships between the donor characteristics and the transplant outcomes. The 1-year patient survival for the DCD group (95%) was not significantly different from that of the ECMO group (87%; P = 0.47) or the DBD group (94%; P = 0.94). Graft survival was slightly inferior in the DCD group (85%) because of a high rate of primary nonfunction (10%) and retransplantation (15%) but was not significantly different from the ECMO group (87%; P = 0.76) or the DBD group (91%; P = 0.20). Although ischemic cholangiopathy was more frequent in the DCD group (10%), this issue did not adversely impact graft survival because none of the recipients underwent retransplantation due to biliary complications. Moreover, the DCD recipients were more likely to develop posttransplant renal dysfunction with the need for renal replacement therapy. Further analysis of the DCD group showed that warm ischemia >125 minutes and an Ishak fibrosis score of 1 at liver biopsy negatively impacted serum creatinine and alanine transaminase levels in the first posttransplant week, respectively. In conclusion, our findings encourage the use of liver grafts from DCD donors maintained by regional perfusion after proper selection.

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Section: Discussioncontrasting

confidence: 60%

Section: Original Article | 1533mentioning

confidence: 99%

Liver Grafts From Donors After Circulatory Death on Regional Perfusion With Extended Warm Ischemia Compared With Donors After Brain Death

et al. 2018

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“…Lactate has been proposed as a marker of tissue perfusion that is influenced by not only macrocirculation but also microcirculation (20). The lactate behavior is highly associated with in-hospital mortality in postcardiotomy patients (12,21). In our investigation, a peak lactate level 20 mmol/L was also a relevant factor for in-hospital mortality.…”

Section: Discussionsupporting

confidence: 48%

Veno‐Arterial Extracorporeal Membrane Oxygenation Support in Patients Undergoing Aortic Surgery

et al. 2017

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Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an option for mechanical support for patients with postcardiotomy cardiogenic shock (PCS). However, the use of VA-ECMO in patients suffering from aortic disease with PCS has not been greatly reported. This is a retrospective review of adult patients undergoing aortic surgery who received VA-ECMO support to treat refractory PCS from August 2009 to May 2016. A total of 36 patients who underwent aortic surgery with VA-ECMO support for refractory PCS were included. Preoperative, perioperative, and postoperative variables were assessed and analyzed for possible correlation with in-hospital mortality. After a mean duration of 3.6 ± 2.9 days, 24 patients (67%) were weaned off VA-ECMO, and 18 patients (50%) were discharged from the hospital. The overall in-hospital mortality was 50%. The main cause of death was multiple organ dysfunction. The survivors had a lower level of preoperative creatine kinase-MB (CK-MB), a higher rate of antegrade cannulation, and a lower lactate level at 12 h, respectively. Relevant factors for in-hospital mortality were retrograde-flow cannulation (odds ratio [OR], 2.49), peak lactate levels greater than 20 mmol/L (OR, 5.0), and preoperative CK-MB greater than 100 IU/L (OR, 6.40). Antegrade cannulation may provide better perfusion and should be emphasized to improve outcomes. Additionally, levels of peak serum lactate and preoperative CK-MB may be relevant factors for in-hospital mortality in aortic patients with PCS.

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“…Arterial lactate before starting VA-ECMO is widely recognized as a predictor of poor outcome [2][3][4][5][6][7], still, to the best of our knowledge, no data exists on the prognostic value of arterial lactate at the time of weaning from VA-ECMO. Similarly, the clearance of arterial lactate, even when adjusted for the duration of this salvage therapy, was also not associated with an increased risk of early mortality.…”

Section: Discussionmentioning

confidence: 99%

“…The identification of risk factors underlying failure to recover after weaning from postcardiotomy VA-ECMO are of clinical importance to establish a protocol for discontinuation of this therapy in patients with unrecoverable end-organ failure as well as to develop strategies to improve the early outcome of postcardiotomy VA-ECMO. Increased levels of arterial lactate before and during ECMO have been shown to predict the outcome of these patients [2][3][4][5][6][7]. In this study, we investigated whether arterial lactate levels at the time of weaning from VA-ECMO is a prognostic factor for weaned patients and could be useful in the decision-making process of the timing of VA-ECMO discontinuation.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation

Biancari

Fiore

Jónsson

et al. 2019

JCM

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Background: The outcome after weaning from postcardiotomy venoarterial extracorporeal membrane oxygenation (VA-ECMO) is poor. In this study, we investigated the prognostic impact of arterial lactate levels at the time of weaning from postcardiotomy VA. Methods: This analysis included 338 patients from the multicenter PC-ECMO registry with available data on arterial lactate levels at weaning from VA-ECMO. Results: Arterial lactate levels at weaning from VA-ECMO (adjusted OR 1.426, 95%CI 1.157-1.758) was an independent predictor of hospital mortality, and its best cutoff values was 1.6 mmol/L (<1.6 mmol/L, 26.2% vs. ≥ 1.6 mmol/L, 45.0%; adjusted OR 2.489, 95%CI 1.374-4.505). When 261 patients with arterial lactate at VA-ECMO weaning ≤2.0 mmol/L were analyzed, a cutoff of arterial lactate of 1.4 mmol/L for prediction of hospital mortality was identified (<1.4 mmol/L, 24.2% vs. ≥1.4 mmol/L, 38.5%, p = 0.014). Among 87 propensity score-matched pairs, hospital mortality was significantly higher in patients with arterial lactate ≥1.4 mmol/L (39.1% vs. 23.0%, p = 0.029) compared to those with lower arterial lactate. Conclusions: Increased arterial lactate levels at the time of weaning from postcardiotomy VA-ECMO increases significantly the risk of hospital mortality. Arterial lactate may be useful in guiding optimal timing of VA-ECMO weaning.

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Blood lactate level during extracorporeal life support as a surrogate marker for survival

Cited by 59 publications

References 19 publications

Liver Grafts From Donors After Circulatory Death on Regional Perfusion With Extended Warm Ischemia Compared With Donors After Brain Death

Liver Grafts From Donors After Circulatory Death on Regional Perfusion With Extended Warm Ischemia Compared With Donors After Brain Death

Veno‐Arterial Extracorporeal Membrane Oxygenation Support in Patients Undergoing Aortic Surgery

Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation

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