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Prognosis of Hypothermic Patients Undergoing ECLS Rewarming—Do Alterations in Biochemical Parameters Matter?

Background: While ECLS is a highly invasive procedure, the identification of patients with a potentially good prognosis is of high importance. The aim of this study was to analyse changes in the acid-base balance parameters and lactate kinetics during the early stages of ECLS rewarming to determine...

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Autores principales: Hymczak, Hubert, Podsiadło, Paweł, Kosiński, Sylweriusz, Pasquier, Mathieu, Mendrala, Konrad, Hudziak, Damian, Gocoł, Radosław, Plicner, Dariusz, Darocha, Tomasz
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8468166/
https://www.ncbi.nlm.nih.gov/pubmed/34574690
http://dx.doi.org/10.3390/ijerph18189764
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author Hymczak, Hubert
Podsiadło, Paweł
Kosiński, Sylweriusz
Pasquier, Mathieu
Mendrala, Konrad
Hudziak, Damian
Gocoł, Radosław
Plicner, Dariusz
Darocha, Tomasz
author_facet Hymczak, Hubert
Podsiadło, Paweł
Kosiński, Sylweriusz
Pasquier, Mathieu
Mendrala, Konrad
Hudziak, Damian
Gocoł, Radosław
Plicner, Dariusz
Darocha, Tomasz
author_sort Hymczak, Hubert
collection PubMed
description Background: While ECLS is a highly invasive procedure, the identification of patients with a potentially good prognosis is of high importance. The aim of this study was to analyse changes in the acid-base balance parameters and lactate kinetics during the early stages of ECLS rewarming to determine predictors of clinical outcome. Methods: This single-centre retrospective study was conducted at the Severe Hypothermia Treatment Centre at John Paul II Hospital in Krakow, Poland. Patients ≥18 years old who had a core temperature (Tc) < 30 °C and were rewarmed with ECLS between December 2013 and August 2018 were included. Acid-base balance parameters were measured at ECLS implantation, at Tc 30 °C, and at 2 and 4 h after Tc 30 °C. The alteration in blood lactate kinetics was calculated as the percent change in serum lactate concentration relative to the baseline. Results: We included 50 patients, of which 36 (72%) were in cardiac arrest. The mean age was 56 ± 15 years old, and the mean Tc was 24.5 ± 12.6 °C. Twenty-one patients (42%) died. Lactate concentrations in the survivors group were significantly lower than in the non-survivors at all time points. In the survivors group, the mean lactate concentration decreased −2.42 ± 4.49 mmol/L from time of ECLS implantation until 4 h after reaching Tc 30 °C, while in the non-survivors’ group (p = 0.024), it increased 1.44 ± 6.41 mmol/L. Conclusions: Our results indicate that high lactate concentration is associated with a poor prognosis for hypothermic patients undergoing ECLS rewarming. A decreased value of lactate kinetics at 4 h after reaching 30 °C is also associated with a poor prognosis.
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spelling pubmed-84681662021-09-27 Prognosis of Hypothermic Patients Undergoing ECLS Rewarming—Do Alterations in Biochemical Parameters Matter? Hymczak, Hubert Podsiadło, Paweł Kosiński, Sylweriusz Pasquier, Mathieu Mendrala, Konrad Hudziak, Damian Gocoł, Radosław Plicner, Dariusz Darocha, Tomasz Int J Environ Res Public Health Article Background: While ECLS is a highly invasive procedure, the identification of patients with a potentially good prognosis is of high importance. The aim of this study was to analyse changes in the acid-base balance parameters and lactate kinetics during the early stages of ECLS rewarming to determine predictors of clinical outcome. Methods: This single-centre retrospective study was conducted at the Severe Hypothermia Treatment Centre at John Paul II Hospital in Krakow, Poland. Patients ≥18 years old who had a core temperature (Tc) < 30 °C and were rewarmed with ECLS between December 2013 and August 2018 were included. Acid-base balance parameters were measured at ECLS implantation, at Tc 30 °C, and at 2 and 4 h after Tc 30 °C. The alteration in blood lactate kinetics was calculated as the percent change in serum lactate concentration relative to the baseline. Results: We included 50 patients, of which 36 (72%) were in cardiac arrest. The mean age was 56 ± 15 years old, and the mean Tc was 24.5 ± 12.6 °C. Twenty-one patients (42%) died. Lactate concentrations in the survivors group were significantly lower than in the non-survivors at all time points. In the survivors group, the mean lactate concentration decreased −2.42 ± 4.49 mmol/L from time of ECLS implantation until 4 h after reaching Tc 30 °C, while in the non-survivors’ group (p = 0.024), it increased 1.44 ± 6.41 mmol/L. Conclusions: Our results indicate that high lactate concentration is associated with a poor prognosis for hypothermic patients undergoing ECLS rewarming. A decreased value of lactate kinetics at 4 h after reaching 30 °C is also associated with a poor prognosis. MDPI 2021-09-16 /pmc/articles/PMC8468166/ /pubmed/34574690 http://dx.doi.org/10.3390/ijerph18189764 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/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 (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Hymczak, Hubert
Podsiadło, Paweł
Kosiński, Sylweriusz
Pasquier, Mathieu
Mendrala, Konrad
Hudziak, Damian
Gocoł, Radosław
Plicner, Dariusz
Darocha, Tomasz
Prognosis of Hypothermic Patients Undergoing ECLS Rewarming—Do Alterations in Biochemical Parameters Matter?
title Prognosis of Hypothermic Patients Undergoing ECLS Rewarming—Do Alterations in Biochemical Parameters Matter?
title_full Prognosis of Hypothermic Patients Undergoing ECLS Rewarming—Do Alterations in Biochemical Parameters Matter?
title_fullStr Prognosis of Hypothermic Patients Undergoing ECLS Rewarming—Do Alterations in Biochemical Parameters Matter?
title_full_unstemmed Prognosis of Hypothermic Patients Undergoing ECLS Rewarming—Do Alterations in Biochemical Parameters Matter?
title_short Prognosis of Hypothermic Patients Undergoing ECLS Rewarming—Do Alterations in Biochemical Parameters Matter?
title_sort prognosis of hypothermic patients undergoing ecls rewarming—do alterations in biochemical parameters matter?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8468166/
https://www.ncbi.nlm.nih.gov/pubmed/34574690
http://dx.doi.org/10.3390/ijerph18189764
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