Patterns of oxygen debt repayment in cardiogenic shock patients sustained with extracorporeal life support: a retrospective study

Abstract

Cardiogenic shock is the most frequent shock in cardiac intensive care, and cardiac dysfunction and sever hypoxia are often seen in critically ill patients. Inadequate organ and tissue perfusion and hypoxia result in anaerobic metabolism with hyperlactatemia and oxygen debt accumulation. However, the role of accumulated oxygen debt in course of cardiogenic shock and hypoxia is not clearly described. Here we first described the existence of several patterns of oxygen debt repayment in cardiogenic shock patients maintained by extracorporeal life support system. Oxygen debt was computed from the lactate concentration at five time points, covering the first 26 hours of ECLS. The patterns as the basic pathophysiological processes are independent from the cause of primary insult. The groups of patients classified to the specific patterns differed by survival rate from 51.5% to only 4.6%. It is very important that initial class does not predetermine the fate and can change in the course of treatment due to ‘between clusters migration’. We believe that our finding of patterns of oxygen debt repayment in cardiogenic shock patients may offer a new insights for a more rational, goal-directed treatment of such highly morbid conditions as hypoxia and cardiogenic shock.