Prognostic value of arterial blood lactate for patients with cardiogenic shock receiving extracorporeal membrane oxy-genation / 中华胸心血管外科杂志

ABSTRACT

Objective To investigate the prognostic value of arterial blood lactate for patients with cardiogenic shock re-ceiving extracorporeal membrane oxygenation( ECMO) . Methods A retrospective analysis was conducted. Twenty-three pa-tients diagnosed with cardiogenic shock receiving veno-arterial( V-A) ECMO admitted to department of Emergency Intensive Care Unit( EICU) of Beijing Luhe Hospital Affiliated to Capital Medical University from January 2017 to December 2018 were enrolled. Results There were 10 cases in the survival group and 13 cases in the death group. Compared with survival group, APACHE-Ⅱ score was higher, CRRT applied higher percentage, PH and oxygenation index was worse in the death group (P<0. 05). The lactate of the death group was significantly higher than that of the survival group at initial time at EICU, 1 h before ECMO and 0h before ECMO(P<0. 05). During the ECMO operation, lactate levels in the death group at 8 h and 12 h were significantly higher than those in the survival group(P<0. 05). There was no statistically significant difference in lactate clearance rate between the two groups before and after ECMO operation in each observation period(P>0. 05). On the 2nd day of ECMO operation, CRRT usage time was shorter and daily liquid balance was more negative in the survival group(P<0. 05). APACHE-Ⅱscore, initial lactate at EICU, lactate at ECMO 8 h and lactate at ECMO 12 h had predictive value for 30-day death of patients. The area under ROC curve( AUC) of initial lactate at EICU was 0. 845, and 95％ confidence interval (95％CI) =0. 653-1. 000. The AUC of ECMO 8 h lactate was 0. 836, 95％CI0. 634-1. 000. The AUC of ECMO 12 h lactate was 0. 873, 95％CI0. 697-1. 000. The AUC of APACHE-Ⅱscore was 0. 891, 95％CI0. 717-1. 000. The sensi-tivity and specificity of prognosis prediction were 72. 7％ and 100％ when lactate was more than 7. 3 mmol/L at the time of ad-mission into EICU as the optimal critical value. Conclusion Arterial blood lactate could be used as an important marker for e-valuating the prognosis of cardiogenic shock patients on ECMO. The value of lactate clearance rate may be affected by combined CRRT.