Serial Lactate Measurements as a Prognostic Tool in Venovenous Extracorporeal Membrane Oxygenation Support

Bonizzoli, Manuela; Lazzeri, Chiara; Cianchi, Giovanni; Boddi, Maria; Cozzolino, Morena; Valvasone, S Di; Terenzi, Paolo; Batacchi, Stefano; Chiostri, Marco; Peris, Adriano

doi:10.1016/j.athoracsur.2016.06.087

Cited by 32 publications

(31 citation statements)

References 26 publications

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“…Several previous studies found that the pre-ECMO lactate level was associated with hospital mortality (4,29,30). In our study, we also found that changes in lactate levels differed markedly between the pre-ECMO overt-DIC and non-overt-DIC groups (and between survivors and nonsurvivors).…”

Section: Discussionmentioning

confidence: 97%

Early changes in coagulation profiles and lactate levels in patients with septic shock undergoing extracorporeal membrane oxygenation

Kim¹,

Cheon²,

Ha³

et al. 2018

J. Thorac. Dis.

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Section: Discussionmentioning

confidence: 97%

Early changes in coagulation profiles and lactate levels in patients with septic shock undergoing extracorporeal membrane oxygenation

Kim¹,

Cheon²,

Ha³

et al. 2018

J. Thorac. Dis.

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“…Among neonatal and pediatric patients undergoing cardiac ECMO, prior studies have shown elevated lactate more than 24–72 hours post-cannulation is associated with increased mortality (18, 19) and that the time required for lactate to normalize (<2 mmol/L) on ECMO is associated with worse cognitive outcome in survivors (20). A recent study in adults receiving VV ECMO for acute respiratory distress syndrome found increased mortality among those who failed to clear lactate within the first 72 hours of ECMO (21). These findings and ours suggest that clearance of lactate may be an important therapeutic target during ECMO.…”

Section: Discussionmentioning

confidence: 99%

Functional Status of Neonatal and Pediatric Patients After Extracorporeal Membrane Oxygenation*

Cashen

Reeder

Dalton

et al. 2017

Pediatric Critical Care Medicine

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Objective To describe functional status at hospital discharge for neonatal and pediatric patients treated with extracorporeal membrane oxygenation (ECMO), and identify factors associated with functional status and mortality. Design Secondary analysis of observational data collected by the Collaborative Pediatric Critical Care Research Network (CPCCRN) between December 2012 and September 2014. Setting Eight hospitals affiliated with the CPCCRN. Patients Patients were <19 years of age and treated with ECMO. Interventions Functional status was evaluated among survivors using the Functional Status Scale (FSS). Total FSS scores range from 6–30 and are categorized as 6–7 (good), 8–9 (mildly abnormal), 10–15 (moderately abnormal), 16–21 (severely abnormal) and >21 (very severely abnormal). Measurements and Main Results Of 514 patients, 267 (52%) were neonates (≤30 days old). Indication for ECMO was respiratory for 237 (46%), cardiac for 207 (40%) and extracorporeal cardiopulmonary resuscitation (eCPR) for 70 (14%). Among 282 survivors, 89 (32%) had good, 112 (40%) mildly abnormal, 67 (24%) moderately abnormal, and 14 (5%) severely or very severely abnormal function at hospital discharge. Among neonates, development of renal failure and longer hospitalization were independently associated with worse FSS. Chronic conditions, prematurity, venoarterial ECMO, increased red cell transfusion in the first 24 hours of ECMO, and longer ECMO duration were independently associated with mortality. Among pediatric patients, chronic neurologic conditions, tracheostomy or home ventilator, eCPR, hepatic dysfunction and longer intensive care unit stay were independently associated with worse FSS. Chronic cardiac conditions, hepatic dysfunction, and neurologic or thrombotic complications were independently associated with mortality. Achieving blood lactate concentration ≤2 mmol/L during ECMO was independently associated with survival in both neonatal and pediatric patients. Conclusions In this study, about half of ECMO patients survived with good, mildly abnormal or moderately abnormal function at hospital discharge. Patient and ECMO related factors are associated with functional status and mortality.

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“…Similarly, in 21 patients with severe ARDS and pulmonary vascular dysfunction requiring venous‐venous ECMO, we documented that survivors exhibited lower lactate levels ( P < 0.001), when compared with dead patients . Finally, lactate measured before ECMO initiation as well as 6 and 24 h after resulted a prognostic factor for early death in 126 patients refractory ARDS treated with ECMO …”

Section: Discussionmentioning

confidence: 58%

A novel risk score for severe ARDS patients undergoing ECMO after retrieval from peripheral hospitals

Lazzeri

Cianchi

Mauri

et al. 2017

Acta Anaesthesiol Scand

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Background: Extracorporeal Membrane Oxygenation in severe ARDS unresponsive to conventional protective ventilation is associated with elevated costs, resource and complications, and appropriate risk stratification of candidate patients could be useful to recognize those more likely to benefit from ECMO. We aimed to derive a new outcome prediction score for patients retrieved by our ECMO team from peripheral centers, including systematic echocardiographic evaluation before ECMO start. Methods: Sixty-nine consecutive patients with refractory ARDS requiring ECMO transferred from peripheral centers to our ICU (a tertiary ECMO referral center), from 1 October 2009 to 31 December 2015, were assessed. Results: All patients were transported on ECMO (distance, median 77, range 4-456 km) The mortality rate was 41% (28/69). Our new risk score included age ≥ 42 years, BMI < 31 kg/m 2 , RV dilatation, and pH < 7.35. The proposed cut off (Youden's index method) of nine had a sensitivity of 96% and a specificity of 30% (AUC-ROC: 0.85, 95% CI: 0.76-0.94, P < 0.001). When assessing the discriminatory ability of our risk score in the population of local patients, survivors had a mean value of 15.4 AE 8.6, whereas non-survivors showed a mean value of 20.1 AE 7.4 (P < 0.001). Conclusions: Our new risk score shows good discriminatory ability both in patients retrieved from peripheral centers and in those implanted at our center. This score includes variables easily available at bedside, and, for the first time, a pathophysiologic element, RV dilatation.

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Serial Lactate Measurements as a Prognostic Tool in Venovenous Extracorporeal Membrane Oxygenation Support

Cited by 32 publications

References 26 publications

Early changes in coagulation profiles and lactate levels in patients with septic shock undergoing extracorporeal membrane oxygenation

Early changes in coagulation profiles and lactate levels in patients with septic shock undergoing extracorporeal membrane oxygenation

Functional Status of Neonatal and Pediatric Patients After Extracorporeal Membrane Oxygenation*

A novel risk score for severe ARDS patients undergoing ECMO after retrieval from peripheral hospitals

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