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Elevated lactate levels and impaired lactate clearance during extracorporeal life support (ECLS) are associated with poor outcome in cardiac surgery patients

The use of extracorporeal life support (ECLS) as part of cardio-circulatory support has increased rapidly in recent years. Severe hyperlactatemia is not uncommon in this group of patients. Lactate peak concentrations and lactate clearance have already been identified as independent marker for mortal...

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Autores principales: Rissel, René, Koelm, Sascha, Schepers, Markus, Dohle, Daniel-Sebastian, Albers, Joerg, Oezkur, Mehmet, Kriege, Marc, Bodenstein, Marc
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9704663/
https://www.ncbi.nlm.nih.gov/pubmed/36441698
http://dx.doi.org/10.1371/journal.pone.0278139
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author Rissel, René
Koelm, Sascha
Schepers, Markus
Dohle, Daniel-Sebastian
Albers, Joerg
Oezkur, Mehmet
Kriege, Marc
Bodenstein, Marc
author_facet Rissel, René
Koelm, Sascha
Schepers, Markus
Dohle, Daniel-Sebastian
Albers, Joerg
Oezkur, Mehmet
Kriege, Marc
Bodenstein, Marc
author_sort Rissel, René
collection PubMed
description The use of extracorporeal life support (ECLS) as part of cardio-circulatory support has increased rapidly in recent years. Severe hyperlactatemia is not uncommon in this group of patients. Lactate peak concentrations and lactate clearance have already been identified as independent marker for mortality in critical ill patients without mechanical device support. The aim of this study was to determine a supposed correlation between the variables lactate peak concentration and clearance in the blood and mortality in the ECLS context. Therefore, a total of 51 cardiac surgery ICU patients with ECLS therapy were included in this retrospective, clinical observational study (survivors n = 23; non-survivors n = 28). Lactate measurement was performed before, during and after ECLS therapy. Further, common ICU scores (SAPSII, SOFA, TISS28), the rates of transfusion and the different vasopressor therapies will be compared. Significant elevated peak lactate levels and poor lactate clearance were associated with higher mortality during ECLS therapy (p < 0.001). Deceased patients had higher SAPSII scores (p < 0.001), received more transfusions (p < 0.001) and presented with higher rates of epinephrine (p < 0.001). In conclusion, hyperlactatemia during ECLS therapy is a time sensitive emergency. Lactate cannot be cleared in all patients. Reversible causes should be explored and treated. In cases where the cause is irreversible, the prognosis of elevated lactate concentrations and reduced clearance is very poor.
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spelling pubmed-97046632022-11-29 Elevated lactate levels and impaired lactate clearance during extracorporeal life support (ECLS) are associated with poor outcome in cardiac surgery patients Rissel, René Koelm, Sascha Schepers, Markus Dohle, Daniel-Sebastian Albers, Joerg Oezkur, Mehmet Kriege, Marc Bodenstein, Marc PLoS One Research Article The use of extracorporeal life support (ECLS) as part of cardio-circulatory support has increased rapidly in recent years. Severe hyperlactatemia is not uncommon in this group of patients. Lactate peak concentrations and lactate clearance have already been identified as independent marker for mortality in critical ill patients without mechanical device support. The aim of this study was to determine a supposed correlation between the variables lactate peak concentration and clearance in the blood and mortality in the ECLS context. Therefore, a total of 51 cardiac surgery ICU patients with ECLS therapy were included in this retrospective, clinical observational study (survivors n = 23; non-survivors n = 28). Lactate measurement was performed before, during and after ECLS therapy. Further, common ICU scores (SAPSII, SOFA, TISS28), the rates of transfusion and the different vasopressor therapies will be compared. Significant elevated peak lactate levels and poor lactate clearance were associated with higher mortality during ECLS therapy (p < 0.001). Deceased patients had higher SAPSII scores (p < 0.001), received more transfusions (p < 0.001) and presented with higher rates of epinephrine (p < 0.001). In conclusion, hyperlactatemia during ECLS therapy is a time sensitive emergency. Lactate cannot be cleared in all patients. Reversible causes should be explored and treated. In cases where the cause is irreversible, the prognosis of elevated lactate concentrations and reduced clearance is very poor. Public Library of Science 2022-11-28 /pmc/articles/PMC9704663/ /pubmed/36441698 http://dx.doi.org/10.1371/journal.pone.0278139 Text en © 2022 Rissel et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Rissel, René
Koelm, Sascha
Schepers, Markus
Dohle, Daniel-Sebastian
Albers, Joerg
Oezkur, Mehmet
Kriege, Marc
Bodenstein, Marc
Elevated lactate levels and impaired lactate clearance during extracorporeal life support (ECLS) are associated with poor outcome in cardiac surgery patients
title Elevated lactate levels and impaired lactate clearance during extracorporeal life support (ECLS) are associated with poor outcome in cardiac surgery patients
title_full Elevated lactate levels and impaired lactate clearance during extracorporeal life support (ECLS) are associated with poor outcome in cardiac surgery patients
title_fullStr Elevated lactate levels and impaired lactate clearance during extracorporeal life support (ECLS) are associated with poor outcome in cardiac surgery patients
title_full_unstemmed Elevated lactate levels and impaired lactate clearance during extracorporeal life support (ECLS) are associated with poor outcome in cardiac surgery patients
title_short Elevated lactate levels and impaired lactate clearance during extracorporeal life support (ECLS) are associated with poor outcome in cardiac surgery patients
title_sort elevated lactate levels and impaired lactate clearance during extracorporeal life support (ecls) are associated with poor outcome in cardiac surgery patients
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9704663/
https://www.ncbi.nlm.nih.gov/pubmed/36441698
http://dx.doi.org/10.1371/journal.pone.0278139
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