Systemic acidemia impairs cardiac function in critically Ill patients

Rodríguez-Villar, S.; Kraut, Jeffrey A.; Arévalo-Serrano, Juan; Sakka, Samir G.; Harris, Clair; Awad, Issam A.; Toolan, Michael; Vanapalli, Sreedevi; Collins, A. G.; Spataru, Amalia; Eiben, Paola; Recea, V; Brathwaite‐Shirley, Charlotte; Thompson, La Dora V.; Gurung, Bimal; Reece-Anthony, R.

doi:10.1016/j.eclinm.2021.100956

Cited by 10 publications

(8 citation statements)

References 35 publications

(42 reference statements)

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“…30 These findings suggest that hyperlactatemia and acidemia may not only be markers of tissue hypoperfusion, but they may potentially have a negative effect on the recovery of the myocardium. 31 The retrospective nature of the studies herein included is the main limitation of the present analysis. Second, the results might be biased by the heterogeneity in the experience and strategies of V-A-ECMO organ support in the participating centers.…”

Section: Discussionmentioning

confidence: 99%

Hyperlactatemia and poor outcome After postcardiotomy veno-arterial extracorporeal membrane oxygenation: An individual patient data meta-Analysis

et al. 2023

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Introduction Postcardiotomy veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) is associated with significant mortality. Identification of patients at very high risk for death is elusive and the decision to initiate V-A-ECMO is based on clinical judgment. The prognostic impact of pre-V-A-ECMO arterial lactate level in these critically ill patients has been herein evaluated. Methods A systematic review was conducted to identify studies on postcardiotomy VA-ECMO for the present individual patient data meta-analysis. Results Overall, 1269 patients selected from 10 studies were included in this analysis. Arterial lactate level at V-A-ECMO initiation was increased in patients who died during the index hospitalization compared to those who survived (9.3 vs 6.6 mmol/L, p < 0.0001). Accordingly, in hospital mortality increased along quintiles of pre-V-A-ECMO arterial lactate level (quintiles: 1, 54.9%; 2, 54.9%; 3, 67.3%; 4, 74.2%; 5, 82.2%, p < 0.0001). The best cut-off for arterial lactate was 6.8 mmol/L (in-hospital mortality, 76.7% vs. 55.7%, p < 0.0001). Multivariable multilevel mixed-effect logistic regression model including arterial lactate level significantly increased the area under the receiver operating characteristics curve (0.731, 95% CI 0.702–0.760 vs 0.679, 95% CI 0.648–0.711, DeLong test p < 0.0001). Classification and regression tree analysis showed the in-hospital mortality was 85.2% in patients aged more than 70 years with pre-V-A-ECMO arterial lactate level ≥6.8 mmol/L. Conclusions Among patients requiring postcardiotomy V-A-ECMO, hyperlactatemia was associated with a marked increase of in-hospital mortality. Arterial lactate may be useful in guiding the decision-making process and the timing of initiation of postcardiotomy V-A-ECMO.

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Section: Discussionmentioning

confidence: 99%

Hyperlactatemia and poor outcome After postcardiotomy veno-arterial extracorporeal membrane oxygenation: An individual patient data meta-Analysis

et al. 2023

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“…Arteries dilate, which may cause hypotension [10]. However, there is limited clinical evidence of the improvement with alkali administration [11]. Except for L-lactic acidosis due to tissue hypoxemia, alkali administration is considered unnecessary in most cases, and unnecessary alkali administration can cause adverse events such as hypokinemia and paradoxical intracellular acidosis.…”

Section: Discussionmentioning

confidence: 99%

Point-of-Care Ultrasound for the Diagnosis of Congestive Kidney Due to Severe Acidemia: A Case Report

Shirai,

Yazawa,

Yoshida

et al. 2024

Cureus

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A 51-year-old woman with mitochondrial myopathy and congestive heart failure with reduced left ventricular ejection fraction was admitted due to loss of appetite and progressive frailty. She presented with acute kidney injury (AKI) and severe acidemia. Given her medical history and physical examination (jugular vein distention was not obvious), prerenal causes (hypovolemia/hypotension) of AKI were considered most likely. However, with a significantly elevated N-terminal pro-b-type natriuretic peptide level of 14,700 pg/mL, a congestive kidney was also considered. Bedside echocardiography showed no evidence of low output syndrome, whereas venous excess ultrasound (VExUS) score was assessed as Grade 2 (moderate congestion). In addition to administering fluids for the suspected prerenal causes (hypovolemia/hypotension), sodium bicarbonate was administered suspecting a negative impact of severe acidemia on cardiac function. With the improvement of acidemia and only a small volume of fluid therapy, there was a rapid improvement in AKI with the normalization of the VExUS score. This suggested that the main cause of AKI was congestive kidney. In this case, VExUS helped us make a correct diagnosis of acidemia-induced congestive kidney rather than hypovolemia as a cause of AKI, leading to the appropriate treatment.

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“…Similarly, ventricular function worsens with decreasing level of pH [ 27 , 29 ]. Depressed ventricular function associated with acidemia has been observed also in the clinical setting [ 30 ]. Therefore, hyperlactatemia and acidemia may have a negative effect on the recovery of the myocardium in TAAD patients.…”

Section: Discussionmentioning

confidence: 99%

Preoperative arterial lactate and outcome after surgery for type A aortic dissection: The ERTAAD multicenter study

Biancari,

Nappi,

Gatti

et al. 2023

Heliyon

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Systemic acidemia impairs cardiac function in critically Ill patients

Cited by 10 publications

References 35 publications

Hyperlactatemia and poor outcome After postcardiotomy veno-arterial extracorporeal membrane oxygenation: An individual patient data meta-Analysis

Hyperlactatemia and poor outcome After postcardiotomy veno-arterial extracorporeal membrane oxygenation: An individual patient data meta-Analysis

Point-of-Care Ultrasound for the Diagnosis of Congestive Kidney Due to Severe Acidemia: A Case Report

Preoperative arterial lactate and outcome after surgery for type A aortic dissection: The ERTAAD multicenter study

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