Serum lactate at 24 hours is associated with outcome in children requiring extracorporeal membrane oxygenation for pulmonary causes – a retrospective, observational study

Abstract

OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) has become an essential life-saving tool. Being resource-intensive, judicious use and optimising the outcomes of this precious resource is important. This retrospective, explanatory, observational study aimed to quantify associations between factors and outcome after pulmonary ECMO in children.METHODS: This study included 39 consecutive ECMO runs in 38 children performed for pulmonary indications at our hospital from 2008 to 2018. Indications included acute respiratory distress syndrome, infection, drowning, meconium aspiration and pulmonary hypertension, among others. Depending on the need for haemodynamic support, 21 patients (53.8%) received veno-venous ECMO, while 18 (46.2%) received veno-arterial ECMO. We sought to compare the 11 non-survivors with the 27 survivors with respect to time-independent and time-dependent variables. Logistic regression models and Cox proportional hazards models were used. Threshold analysis was done using the "minimum p-value approach". RESULTS: 27/39 (69%) ECMO runs could be weaned; 27/38 (71%) patients were discharged. 20/27 (74%) survivors had unremarkable neurological status, six (22%) had mild findings (convulsions, muscular hypotony, neuropathy) and one (4%) had a hemi-syndrome at discharge. Univariate analyses showed a hazard ratio (HR) of 0.48 for log(pH) (95% confidence interval [CI] 0.22 to 1.02, p = 0.055) and an HR of 4.48 for log(lactate) (95% CI 1.92 to 10.48, p = 0.0005). Multivariate models showed an HR of 0.99 for log(pH) (95% CI 0.43 to 2.26, p = 0.98) and an HR of 4.44 for log(lactate) (95% CI 1.65 to 11.95, p = 0.003). Threshold analysis showed lactate >4.1 to be associated with mortality, with an HR of 32.7 (95% CI 4.8 to 221.7, p = 0.0002). This threshold should, however, be interpret-ed very cautiously. Evidence of an association between serum lactate at 24 hours and mortality was found (difference between survivors and non-survivors: −2.78, 95% CI −5.36 to −0.20, p = 0.037). CONCLUSIONS:The results of ECMO for pulmonary indications are very good. Serum lactate may be an early prognostic indicator.

Risk Factors and Outcomes of Children with Congenital Heart Disease on Extracorporeal Membrane Oxygenation—A Ten-Year Single-Center Report

“…Factors other than anatomy may also impact survival probability. High inotrope scores, pre-ECMO acidosis, elevated pre-ECMO lactate, failure to clear lactate within 24 h, bleeding while on ECMO, fluid overload, peripheral cannulation, renal failure, start of ECMO in the intensive care unit, and length of ECMO support are some of the factors that have been discussed in the literature, although not always with consistent conclusions [23][24][25][26]. In terms of pH and lactate levels, we found higher lactate levels and lower mean pH values in the group of children with biventricular hearts (pH 7.06 vs. 7.23, lactate 6.93 vs. 6.05).…”

Open abdomen during extracorporeal membrane oxygenation is a safe and effective treatment for abdominal compartment syndrome

“…One would expect patients with a high VIS to have higher lactate levels due to poor end organ perfusion. Because of this relationship between serum lactate and perfusion, lactate clearance is an important indicator of a patient's status on ECMO support and has been recently described as predictive of survival in children on ECMO by Amodeo [8]. In our study, the open abdomen patients began ECMO treatment with a high mean serum lactate, and their lactate levels normalized by 72 hours after ECMO initiation: this ability to clear lactate provides support for the relatively high survival rate in our open abdomen group.…”

Application of in Vitro Membrane Pulmonary Oxygenation Technology (ECMO) in Neonatal Respiratory Failure

“…The analysis may be related to persistent hypoxemia and low perfusion status. Lactic acid is a byproduct of anaerobic respiratory metabolism in cells, and its concentration of lactic acid reflects the body's tissue perfusion state and oxygen metabolism level [1]. Various causes lead to neonatal respiratory failure, body tissue cells in the hypoxia and low perfusion state, and an increase in blood lactic acid concentration.…”