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

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 fr...

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Autores principales: Biancari, Fausto, Fiore, Antonio, Jónsson, Kristján, Gatti, Giuseppe, Zipfel, Svante, Ruggieri, Vito G., Perrotti, Andrea, Bounader, Karl, Loforte, Antonio, Lechiancole, Andrea, Saeed, Diyar, Lichtenberg, Artur, Pol, Marek, Spadaccio, Cristiano, Pettinari, Matteo, Mogianos, Krister, Alkhamees, Khalid, Mariscalco, Giovanni, El Dean, Zein, Settembre, Nicla, Welp, Henryk, Dell’Aquila, Angelo M., Fux, Thomas, Juvonen, Tatu, Dalén, Magnus
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947236/
https://www.ncbi.nlm.nih.gov/pubmed/31847464
http://dx.doi.org/10.3390/jcm8122218
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author Biancari, Fausto
Fiore, Antonio
Jónsson, Kristján
Gatti, Giuseppe
Zipfel, Svante
Ruggieri, Vito G.
Perrotti, Andrea
Bounader, Karl
Loforte, Antonio
Lechiancole, Andrea
Saeed, Diyar
Lichtenberg, Artur
Pol, Marek
Spadaccio, Cristiano
Pettinari, Matteo
Mogianos, Krister
Alkhamees, Khalid
Mariscalco, Giovanni
El Dean, Zein
Settembre, Nicla
Welp, Henryk
Dell’Aquila, Angelo M.
Fux, Thomas
Juvonen, Tatu
Dalén, Magnus
author_facet Biancari, Fausto
Fiore, Antonio
Jónsson, Kristján
Gatti, Giuseppe
Zipfel, Svante
Ruggieri, Vito G.
Perrotti, Andrea
Bounader, Karl
Loforte, Antonio
Lechiancole, Andrea
Saeed, Diyar
Lichtenberg, Artur
Pol, Marek
Spadaccio, Cristiano
Pettinari, Matteo
Mogianos, Krister
Alkhamees, Khalid
Mariscalco, Giovanni
El Dean, Zein
Settembre, Nicla
Welp, Henryk
Dell’Aquila, Angelo M.
Fux, Thomas
Juvonen, Tatu
Dalén, Magnus
author_sort Biancari, Fausto
collection PubMed
description 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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spelling pubmed-69472362020-01-13 Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation Biancari, Fausto Fiore, Antonio Jónsson, Kristján Gatti, Giuseppe Zipfel, Svante Ruggieri, Vito G. Perrotti, Andrea Bounader, Karl Loforte, Antonio Lechiancole, Andrea Saeed, Diyar Lichtenberg, Artur Pol, Marek Spadaccio, Cristiano Pettinari, Matteo Mogianos, Krister Alkhamees, Khalid Mariscalco, Giovanni El Dean, Zein Settembre, Nicla Welp, Henryk Dell’Aquila, Angelo M. Fux, Thomas Juvonen, Tatu Dalén, Magnus J Clin Med Article 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. MDPI 2019-12-15 /pmc/articles/PMC6947236/ /pubmed/31847464 http://dx.doi.org/10.3390/jcm8122218 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Biancari, Fausto
Fiore, Antonio
Jónsson, Kristján
Gatti, Giuseppe
Zipfel, Svante
Ruggieri, Vito G.
Perrotti, Andrea
Bounader, Karl
Loforte, Antonio
Lechiancole, Andrea
Saeed, Diyar
Lichtenberg, Artur
Pol, Marek
Spadaccio, Cristiano
Pettinari, Matteo
Mogianos, Krister
Alkhamees, Khalid
Mariscalco, Giovanni
El Dean, Zein
Settembre, Nicla
Welp, Henryk
Dell’Aquila, Angelo M.
Fux, Thomas
Juvonen, Tatu
Dalén, Magnus
Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation
title Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation
title_full Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation
title_fullStr Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation
title_full_unstemmed Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation
title_short Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation
title_sort prognostic significance of arterial lactate levels at weaning from postcardiotomy venoarterial extracorporeal membrane oxygenation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947236/
https://www.ncbi.nlm.nih.gov/pubmed/31847464
http://dx.doi.org/10.3390/jcm8122218
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