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Boyacı Dundar N, İnci K, Turkoglu M, Aygencel G. Comparison of lactate/albumin ratio and established scoring systems for predicting mortality in critically ill cirrhotic patients. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116:539-545. [PMID: 38874000 DOI: 10.17235/reed.2024.10450/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
BACKGROUND critically ill cirrhotic patients may present a serious clinical condition defined as acute-on-chronic liver failure with high mortality. While established scoring systems like Child-Pugh and Model for End-stage Liver Disease (MELD) offer prognostic insights, their limitations warrant exploration of alternative markers. The lactate/albumin ratio (LAR) serves as a potential prognostic indicator in critical care settings, yet its utility in cirrhotic patients remains underexplored. METHODS one hundred and seventy-five critically ill cirrhotic patients were assessed in this retrospective cohort study. Clinical severity scores, including Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and Chronic Liver Failure-Organ Failure Score (CLIF-OF) were compared with LAR along with traditional liver failure scoring systems. Logistic regression and receiver operating characteristic (ROC) curve analysis were used to evaluate prognostic performance. RESULTS Intensive Care Unit (ICU) nonsurvivors had significantly higher scores in all liver failure and clinical severity scores compared to survivors (p < 0.001). Median LAR was significantly higher in nonsurvivors (p < 0.001). ROC analysis revealed comparable prognostic accuracy between LAR, APACHE II, SOFA, and CLIF-OF scores in predicting ICU mortality. Logistic regression identified SOFA score at 48th hour, LAR, and requirement of mechanical ventilation as independent predictors of ICU mortality. CONCLUSION LAR demonstrates promising prognostic utility in predicting ICU mortality among critically ill cirrhotic patients, complementing established scoring systems. Early reassessment using SOFA score at 48th hour may guide therapeutic interventions and improve patient outcomes. Further prospective studies are warranted to validate these findings and optimize clinical management strategies.
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Affiliation(s)
| | - Kamil İnci
- Division of Intensive Care Medicine, Gazi University School of Medicine, Turkey
| | - Melda Turkoglu
- Division of Intensive Care Medicine, Gazi University School of Medicine, Turkey
| | - Gulbin Aygencel
- Division of Intensive Care Medicine, Gazi University School of Medicine, Turkey
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Wang HX, Huang XH, Ma LQ, Yang ZJ, Wang HL, Xu B, Luo MQ. Association between lactate-to-albumin ratio and short-time mortality in patients with acute respiratory distress syndrome. J Clin Anesth 2024; 99:111632. [PMID: 39326299 DOI: 10.1016/j.jclinane.2024.111632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 07/31/2024] [Accepted: 09/16/2024] [Indexed: 09/28/2024]
Abstract
STUDY OBJECTIVE The lactate-to-albumin ratio (LAR) has been confirmed to be an effective prognostic marker in sepsis, heart failure, and acute respiratory failure. However, the relationship between LAR and mortality in patients with acute respiratory distress syndrome (ARDS) remains unclear. We aim to evaluate the predictive value of LAR for ARDS patients. DESIGN A retrospective cohort study. SETTING Medical Information Mart for Intensive Care IV (v2.2) database. PATIENTS 769 patients with acute respiratory distress syndrome(ARDS). INTERVENTIONS We divided the patients into two subgroups according to the primary study endpoint (28-days all-cause mortality): the 28-day survivors and the 28-day non-survivors. MEASURES Multivariate Cox Regression, Receiver Operator Characteristic (ROC) and Kaplan-Meier survival analysis were used to investigate the relationship between LAR and short-time mortality in patients with ARDS. MAIN RESULTS The 28-day mortality was 38 % in this study. Multivariable Cox regression analysis showed that LAR was an independent predictive factor for 28-day mortality (HR 1.11, 95 %CI: 1.06-1.16, P < 0.001). The area under curve (AUC) of LAR in the ROC was 70.34 % (95 %CI: 66.53 % - 74.15 %) that provided significantly higher discrimination compared with lactate (AUC = 68.00 %, P = 0.0007) or albumin (AUC = 63.17 %, P = 0.002) alone. LAR was also not inferior to SAPSII with the AUC of 73.44 % (95 %CI: 69.84 % - 77.04 %, P = 0.21). Additionally, Kaplan-Meier survival analysis displayed that ARDS patients with high LAR (> the cut-off value 0.9055) had a significantly higher 28-day overall mortality rate (P < 0.001) and in-hospital mortality rate (P < 0.001). However, patients in high LAR group had shorter length of hospital stay (P < 0.001), which might be caused by higher in-hospital mortality. CONCLUSIONS We confirmed that there was a positive correlation between LAR and 28-day mortality. This could provide anesthesiologists and critical care physicians with a more convenient tool than SAPSII without being superior for detecting ARDS patients with poor prognosis timely.
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Affiliation(s)
- He-Xuan Wang
- Department of Anesthesiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Xue-Hua Huang
- Department of Pain, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200438, China
| | - Li-Qing Ma
- Department of Anesthesiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Zhou-Jing Yang
- Department of Anesthesiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Hai-Lian Wang
- Department of Anesthesiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Bo Xu
- Department of Anesthesiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China.
| | - Meng-Qiang Luo
- Department of Anesthesiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China.
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Jin N, Pang X, Song S, Zheng J, Liu Z, Gu T, Yu Y. A comparative study of femoral artery and combined femoral and axillary artery cannulation in veno-arterial extracorporeal membrane oxygenation patients. Front Cardiovasc Med 2024; 11:1388577. [PMID: 39359639 PMCID: PMC11445077 DOI: 10.3389/fcvm.2024.1388577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 08/27/2024] [Indexed: 10/04/2024] Open
Abstract
Objective Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a critical support technique for cardiac surgery patients. This study compares the outcomes of femoral artery cannulation vs. combined femoral and axillary artery cannulation in post-cardiotomy VA-ECMO patients. This study aimed to compare the clinical outcomes of critically ill patients post-cardiac surgery under VA-ECMO support using different cannulation strategies. Specifically, the focus was on the impact of femoral artery (FA) cannulation vs. combined femoral artery and axillary artery (FA+AA) cannulation on patient outcomes. Methods Through a retrospective analysis, we compared 51 adult patients who underwent cardiac surgery and received VA-ECMO support based on the cannulation strategy employed-FA cannulation in 27 cases vs. FA+AA cannulation in 24 cases. Results The FA+AA group showed significant advantages over the FA group in terms of the incidence of chronic renal failure (CRF) (37.50% vs. 14.81%, p = 0.045), preoperative blood filtration requirement (37.50% vs. 11.11%, p = 0.016), decreased platelet count (82.67 ± 44.95 vs. 147.33 ± 108.79, p = 0.014), and elevated creatinine (Cr) levels (151.80 ± 60.73 vs. 110.26 ± 57.99, p = 0.041), although the two groups had similar 30-day mortality rates (FA group 40.74%, FA+AA group 33.33%). These findings underscore that a combined approach may offer more effective hemodynamic support and better clinical outcomes when selecting an ECMO cannulation strategy. Conclusion Despite the FA+AA group patients presenting with more preoperative risk factors, this group has exhibited lower rates of complications and faster recovery during ECMO treatment. While there has been no significant difference in 30-day mortality rates between the two cannulation strategies, the FA+AA approach may be more effective in reducing complications and improving limb ischemia. These findings highlight the importance of individualized treatment strategies and meticulous monitoring in managing post-cardiac surgery ECMO patients.
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Affiliation(s)
- Na Jin
- Department of Cardiac Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Xin Pang
- Department of Cardiac Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Shiyang Song
- Department of Cardiac Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Jin Zheng
- Department of Cardiac Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Zhimeng Liu
- Department of Cardiac Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Tianxiang Gu
- Department of Cardiac Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Yang Yu
- Department of Cardiac Surgery, The First Hospital of China Medical University, Shenyang, China
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Jung C, Bruno RR, Jumean M, Price S, Krychtiuk KA, Ramanathan K, Dankiewicz J, French J, Delmas C, Mendoza AA, Thiele H, Soussi S. Management of cardiogenic shock: state-of-the-art. Intensive Care Med 2024:10.1007/s00134-024-07618-x. [PMID: 39254735 DOI: 10.1007/s00134-024-07618-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 08/18/2024] [Indexed: 09/11/2024]
Abstract
The management of cardiogenic shock is an ongoing challenge. Despite all efforts and tremendous use of resources, mortality remains high. Whilst reversing the underlying cause, restoring/maintaining organ perfusion and function are cornerstones of management. The presence of comorbidities and preexisting organ dysfunction increases management complexity, aiming to integrate the needs of vital organs in each individual patient. This review provides a comprehensive overview of contemporary literature regarding the definition and classification of cardiogenic shock, its pathophysiology, diagnosis, laboratory evaluation, and monitoring. Further, we distill the latest evidence in pharmacologic therapy and the use of mechanical circulatory support including recently published randomized-controlled trials as well as future directions of research, integrating this within an international group of authors to provide a global perspective. Finally, we explore the need for individualization, especially in the face of neutral randomized trials which may be related to a dilution of a potential benefit of an intervention (i.e., average effect) in this heterogeneous clinical syndrome, including the use of novel biomarkers, artificial intelligence, and machine learning approaches to identify specific endotypes of cardiogenic shock (i.e., subclasses with distinct underlying biological/molecular mechanisms) to support a more personalized medicine beyond the syndromic approach of cardiogenic shock.
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Affiliation(s)
- Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Medical Faculty, Duesseldorf, Germany.
- Cardiovascular Research Institute Düsseldorf (CARID), Düsseldorf, Germany, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
| | - Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | | | - Susanna Price
- Division of Heart, Lung and Critical Care, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Konstantin A Krychtiuk
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Kollengode Ramanathan
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
- Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Josef Dankiewicz
- Department of Clinical Sciences Lund, Lund University, Cardiology, Lund, Sweden
| | - John French
- Department of Cardiology, Liverpool Hospital, Sydney, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
- South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia
| | - Clement Delmas
- Intensive Cardiac Care Unit, Cardiology Department, Toulouse University Hospital, Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
- REICATRA, Institut Saint Jacques, CHU de Toulouse, Toulouse, France
| | | | - Holger Thiele
- Department of Internal Medicine/Cardiology and Leipzig Heart Science, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Sabri Soussi
- Department of Anesthesia and Pain Management, University Health Network (UHN), Women's College Hospital, University of Toronto, Toronto Western Hospital, Toronto, Canada
- University of Paris Cité, Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Paris, France
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Hang MM, Shen MR, Chen TL, Wang Y. Factors influencing the prognosis of patients with cardiogenic shock treated with extracorporeal membrane oxygenation: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e38600. [PMID: 39151538 PMCID: PMC11332715 DOI: 10.1097/md.0000000000038600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/01/2024] [Accepted: 05/24/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Cardiogenic shock is a clinical syndrome caused by primary heart disease that results in decreased cardiac output and insufficient systemic perfusion. A study was conducted to determine what factors affect survival in patients with cardiogenic shock treated with extracorporeal membrane oxygenation (ECMO). METHODS A systematic search was conducted across various databases, including CKNI, VIP, Wan Fang, CBM, Embase, PubMed, Cochrane Library, and Web of Science databases, to gather factors linked to the prognosis of patients with cardiogenic shock who underwent ECMO treatment. The search period for each database was set to conclude on April 30, 2024. RESULTS The findings suggest that, in comparison to the death group, the lactic acid levels of the survival group after treatment were significantly lower (95% confidence interval [CI]: -0.79, -0.58). In addition, the creatinine levels of the survival group after treatment were also significantly lower than those of the death group (95% CI: -0.39, -0.14). Furthermore, the troponin levels in the survival group after treatment were lower than those in the death group (95% CI: -0.32, 0.04), and the total bilirubin levels in the survival group after treatment were also lower than those in the death group (95% CI: -0.62, -0.23). CONCLUSIONS According to the study, total bilirubin, creatinine, and lactic acid levels were lower in the survival group than in the death group when ECMO was used to treat cardiogenic patients, suggesting a better prognosis for patients with cardiogenic shock. Therefore, total bilirubin, creatinine, and lactic acid could be influential factors in the prognosis of survival in patients with cardiogenic shock.
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Affiliation(s)
- Ming-Ming Hang
- Zhejiang Chinese Medicine University, Third Clinical Medical College, Hangzhou, Zhejiang Province, China
| | - Mei-Rong Shen
- Zhejiang Chinese Medicine University, Third Clinical Medical College, Hangzhou, Zhejiang Province, China
| | - Tie-Long Chen
- Hangzhou Hospital of Traditional Chinese Medicine, Third Clinical Medical College, Hangzhou, Zhejiang Province, China
| | - Yu Wang
- Hangzhou Hospital of Traditional Chinese Medicine, Third Clinical Medical College, Hangzhou, Zhejiang Province, China
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Billig H, Al Zaidi M, Quacken F, Görtzen-Patin J, Goody PR, Gräff I, Nickenig G, Zimmer S, Aksoy A. Blood glucose and lactate levels as early predictive markers in patients presenting with cardiogenic shock: A retrospective cohort study. PLoS One 2024; 19:e0306107. [PMID: 39052641 PMCID: PMC11271948 DOI: 10.1371/journal.pone.0306107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/11/2024] [Indexed: 07/27/2024] Open
Abstract
Lactate and glucose are widely used biochemical parameters in current predictive risk scores for cardiogenic shock. Data regarding the relationship between lactate and glucose levels in cardiogenic shock are limited. Thus, we aimed to analyze glucose and lactate as early markers for in-hospital mortality in cardiogenic shock. In this retrospective cohort study, 312 patients presenting with cardiogenic shock to a tertiary-care hospital between 2016 and 2018 were included. Apparent cardiogenic shock was defined as hypoperfusion with hemodynamic compromise and biochemical marker increase due to diminished tissue perfusion, corresponding to SCAI shock stages. In-hospital mortality was assessed as the primary endpoint. The median age of the study population was 71 (60-79) years and the etiology of cardiogenic shock was acute myocardial infarction in 45.8%. Overall in-hospital mortality was 67.6%. In the receiver operating curve analysis, the area under the receiver-operating curve (AUC) for prediction of in-hospital mortality was higher for lactate (AUC: 0.757) than for glucose (AUC: 0.652). Both values were significantly associated with outcome (groups created with best cutoff values obtained from the Youden index). Correlation analysis showed a significant non-linear association of both values. In a multivariable stepwise Cox regression analysis, lactate remained an independent predictor for in-hospital mortality, whilst glucose, despite being implicated in energy metabolism, was not independently predictive for mortality. Together, these data suggest that lactate at admission is superior for mortality prediction in patients with apparent cardiogenic shock. Glucose was not independently predictive for mortality.
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Affiliation(s)
- Hannah Billig
- Department of Cardiology—University Hospital Bonn, Bonn, Germany
| | | | - Florian Quacken
- Department of Cardiology—University Hospital Bonn, Bonn, Germany
| | | | | | - Ingo Gräff
- Department of clinical acute- and emergency medicine, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Cardiology—University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Cardiology—University Hospital Bonn, Bonn, Germany
| | - Adem Aksoy
- Department of Cardiology—University Hospital Bonn, Bonn, Germany
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Li C, Wang Y, Wang X, Shao C, Xin M, Xu B, Hao X, Jia M, Yang F, Wang L, Wang H, Hou X, Du Z. Acute kidney injury and cardiogenic shock severity for mortality risk stratification in patients supported with VA ECMO. ESC Heart Fail 2024. [PMID: 39034632 DOI: 10.1002/ehf2.14967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/18/2024] [Accepted: 06/24/2024] [Indexed: 07/23/2024] Open
Abstract
AIMS To assess the stage of acute kidney injury (AKI), as an index of organ perfusion, combined with shock severity, measured by the Society for Cardiovascular Angiography and Interventions (SCAI) shock stage classification, to stratify the risk of mortality in patients diagnosed with cardiogenic shock (CS) and supported with venoarterial extracorporeal membrane oxygenation (VA ECMO). METHODS ANS RESULTS From January 2018 to December 2020, consecutive adult patients diagnosed with CS and received VA ECMO were retrospectively evaluated. The highest AKI stage within 48 h after ECMO initiation was assessed using the Kidney Disease: Improving Global Outcomes criteria. We included 216 patients with a mean age of 58.8 years and 31.0% were females. 88.4% of patients received ECMO for postcardiotomy, while 11.6% for medical CS. The total in-hospital mortality was 53.2%. AKI occurred in 182 (84.3%) patients receiving ECMO for CS. AKI stage 0, 1, 2, and 3 were present in 15.7%, 17.6%, 18.1%, and 48.6% of patients with in-hospital mortality of 26.5%, 26.3%, 61.5%, and 68.6%, respectively (P < 0.001). The AKI stage (P < 0.001), SCAI shock stage before ECMO (P = 0.008), and NYHA ≥ Class III on admission (P = 0.044) were independent predictors of in-hospital mortality. The area under the receiver operating characteristic curve of 0.754 (95% confidence interval: 0.690 to 0.811) for AKI stage combined with SCAI shock stage was better than those for AKI stage (0.676), SCAI shock stage (0.657), serum lactate level (0.682), SOFA score (0.644), SVAE score (0.582), and VIS score (0.530) prior to ECMO. CONCLUSIONS In this single-center CS population who received VA ECMO for circulatory support, predominantly postcardiotomy cases, AKI occurred in 84.3% of the patients. AKI stage, as an index of organ perfusion combined with shock severity measured by the SCAI shock classification, demonstrates a good correlation with in-hospital mortality.
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Affiliation(s)
- Chenglong Li
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yiwen Wang
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaomeng Wang
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chengcheng Shao
- Cardiac Intensive Care Unit, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Meng Xin
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Bo Xu
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xing Hao
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ming Jia
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Feng Yang
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Liangshan Wang
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hong Wang
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaotong Hou
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhongtao Du
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Wu X, Yuan L, Xu J, Qi J, Zheng K. Normalized lactate load as an independent prognostic indicator in patients with cardiogenic shock. BMC Cardiovasc Disord 2024; 24:348. [PMID: 38987706 PMCID: PMC11234684 DOI: 10.1186/s12872-024-04013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 06/26/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Early prognosis evaluation is crucial for decision-making in cardiogenic shock (CS) patients. Dynamic lactate assessment, for example, normalized lactate load, has been a better prognosis predictor than single lactate value in septic shock. Our objective was to investigate the correlation between normalized lactate load and in-hospital mortality in patients with CS. METHODS Data were extracted from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The calculation of lactate load involved the determination of the cumulative area under the lactate curve, while normalized lactate load was computed by dividing the lactate load by the corresponding period. Receiver Operating Characteristic (ROC) curves were constructed, and the evaluation of areas under the curves (AUC) for various parameters was performed using the DeLong test. RESULTS Our study involved a cohort of 1932 CS patients, with 687 individuals (36.1%) experiencing mortality during their hospitalization. The AUC for normalized lactate load demonstrated significant superiority compared to the first lactate (0.675 vs. 0.646, P < 0.001), maximum lactate (0.675 vs. 0.651, P < 0.001), and mean lactate (0.675 vs. 0.669, P = 0.003). Notably, the AUC for normalized lactate load showed comparability to that of the Sequential Organ Failure Assessment (SOFA) score (0.675 vs. 0.695, P = 0.175). CONCLUSION The normalized lactate load was an independently associated with the in-hospital mortality among CS patients.
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Affiliation(s)
- Xia Wu
- Emergency Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Lin Yuan
- Emergency Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
| | - Jiarui Xu
- Emergency Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Jing Qi
- Emergency Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Keyang Zheng
- Centre of Hypertension, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
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Kruse JM, Nee J, Eckardt KU, Wengenmayer T. [Open questions with respect to extracorporeal circulatory support 2024]. Med Klin Intensivmed Notfmed 2024; 119:346-351. [PMID: 38568446 DOI: 10.1007/s00063-024-01131-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 05/28/2024]
Abstract
The use of extracorporeal circulatory support, both for cardiogenic shock and during resuscitation, still presents many unanswered questions. The inclusion and exclusion criteria for such a resource-intensive treatment must be clearly defined, considering that these criteria are directly associated with the type and location of treatment. For example, it is worth questioning the viability of an extracorporeal resuscitation program in areas where it is impossible to achieve low-flow times under 60 min due to local limitations. Additionally, the best approach for further treatment, including whether it is necessary to regularly relieve the left ventricle, must be explored. To find answers to some of these questions, large-scale, multicenter, randomized studies and registers must be performed. Until then this treatment must be carefully considered before use.
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Affiliation(s)
- J-M Kruse
- Medizinische Klinik mit Schwerpunkt Nephrologie und internistische Intensivmedizin, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - J Nee
- Medizinische Klinik mit Schwerpunkt Nephrologie und internistische Intensivmedizin, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - K-U Eckardt
- Medizinische Klinik mit Schwerpunkt Nephrologie und internistische Intensivmedizin, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - T Wengenmayer
- Interdisziplinäre Medizinische Intensivtherapie (IMT), Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland
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10
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Trebuian CI, Marza AM, Chioibaş R, Şutoi D, Petrica A, Crintea-Najette I, Popa D, Borcan F, Flondor D, Mederle OA. Lactate Profile Assessment-A Good Predictor of Prognosis in Patients with COVID-19 and Septic Shock Requiring Continuous Renal Therapy. Clin Pract 2024; 14:980-994. [PMID: 38921256 PMCID: PMC11202829 DOI: 10.3390/clinpract14030078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/14/2024] [Accepted: 05/24/2024] [Indexed: 06/27/2024] Open
Abstract
INTRODUCTION Lactate is a useful prognostic marker, as its level increases in hypoxic tissue and/or during accelerated aerobic glycolysis due to excessive beta-adrenergic stimulation and decreased lactate clearance. The Surviving Sepsis Campaign Bundle 2018 Update suggests premeasurement of lactate within 2-4 h so that physicians perform, assist, administer, and introduce lactate-guided resuscitation to reduce mortality due to sepsis. METHODS A total of 108 patients with septic shock who underwent continuous renal replacement therapy (CRRT) for acute kidney injury were enrolled in this observational study. Demographic, clinical, and laboratory data were collected, and patients were divided into two groups: survivors and non-survivors. RESULTS Multivariate analysis demonstrated that lactate levels at 24 h after initiation of CRRT treatment, but not lactate levels at intensive care unit (ICU) admission, were associated with mortality. Lactate clearance was associated with lower mortality among the survivors (OR = 0.140) at 6 h after ICU admission and late mortality (OR = 0.260) after 24 h. The area under the ROC curves for mortality was 0.682 for initial lactate; 0.797 for lactate at 24 h; and 0.816 for lactate clearance at 24 h. CONCLUSIONS Our result reinforces that the determination of lactate dynamics represents a good predictor for mortality, and serial lactate measurements may be more useful prognostic markers than initial lactate in patients with septic shock.
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Affiliation(s)
- Cosmin Iosif Trebuian
- Department of Surgery I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania; (C.I.T.); (A.M.M.); (D.Ş.); (A.P.); (I.C.-N.); (D.P.); (O.A.M.)
- Department of Anesthesia and Intensive Care, Emergency County Hospital Resita, 320210 Resita, Romania
| | - Adina Maria Marza
- Department of Surgery I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania; (C.I.T.); (A.M.M.); (D.Ş.); (A.P.); (I.C.-N.); (D.P.); (O.A.M.)
- Emergency Department, Emergency Clinical Municipal Hospital Timisoara, 300079 Timisoara, Romania
| | - Raul Chioibaş
- Department of Surgery I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania; (C.I.T.); (A.M.M.); (D.Ş.); (A.P.); (I.C.-N.); (D.P.); (O.A.M.)
| | - Dumitru Şutoi
- Department of Surgery I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania; (C.I.T.); (A.M.M.); (D.Ş.); (A.P.); (I.C.-N.); (D.P.); (O.A.M.)
| | - Alina Petrica
- Department of Surgery I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania; (C.I.T.); (A.M.M.); (D.Ş.); (A.P.); (I.C.-N.); (D.P.); (O.A.M.)
- Emergency Department of “Pius Brinzeu”, Emergency Clinical County Hospital Timisoara, 300736 Timisoara, Romania
| | - Iulia Crintea-Najette
- Department of Surgery I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania; (C.I.T.); (A.M.M.); (D.Ş.); (A.P.); (I.C.-N.); (D.P.); (O.A.M.)
- Emergency Department, Emergency Clinical Municipal Hospital Timisoara, 300079 Timisoara, Romania
| | - Daian Popa
- Department of Surgery I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania; (C.I.T.); (A.M.M.); (D.Ş.); (A.P.); (I.C.-N.); (D.P.); (O.A.M.)
- Emergency Department, Emergency Clinical Municipal Hospital Timisoara, 300079 Timisoara, Romania
| | - Florin Borcan
- Faculty of Pharmacy, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania; (F.B.); (D.F.)
| | - Daniela Flondor
- Faculty of Pharmacy, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania; (F.B.); (D.F.)
- Research Center for Pharmaco-Toxicological Evaluation, Victor Babes University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania
| | - Ovidiu Alexandru Mederle
- Department of Surgery I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania; (C.I.T.); (A.M.M.); (D.Ş.); (A.P.); (I.C.-N.); (D.P.); (O.A.M.)
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Lovrić D, Pašalić M, Križanac S, Kovačić K, Skorić B, Jurin H, Miličić D, Premužić V. The addition of Cytosorb in patients on VA-ECMO improves urinary output and ICU survival. Ther Apher Dial 2024; 28:103-111. [PMID: 37697687 DOI: 10.1111/1744-9987.14064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 03/18/2023] [Accepted: 09/01/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION The aim of this study was to analyze the efficiency of CytoSorb adsorber in patients presenting with cardiogenic shock and treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO). METHODS Sixteen patients put on VA ECMO due to cardiogenic shock were included, stratified according to the use of Cytosorb adsorber in the first 24 h and compared across different clinical outcomes. RESULTS Significantly lower vasopressor doses were required among patients treated with Cytosorb at the initiation and before weaning from ECMO. Furthermore, these patients showed significantly higher urine output before weaning and lower lactate levels during the extracorporeal support. Finally, the mortality rate was lower among the Cytosorb therapy group (22.2% vs 57.1%). CONCLUSION While a decrease in vasopressor doses was already associated with CytoSorb use, this is the first study showing an increase in urinary output and a trend towards better survival among patients on VA ECMO treated with CytoSorb.
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Affiliation(s)
- Daniel Lovrić
- Cardiology Clinic, University Hospital Center Zagreb, Zagreb, Croatia
| | - Marijan Pašalić
- Cardiology Clinic, University Hospital Center Zagreb, Zagreb, Croatia
| | | | - Karla Kovačić
- Emergency Medicine Institute of Koprivnica-Križevci County, Koprivnica, Croatia
| | - Boško Skorić
- Cardiology Clinic, University Hospital Center Zagreb, Zagreb, Croatia
| | - Hrvoje Jurin
- Cardiology Clinic, University Hospital Center Zagreb, Zagreb, Croatia
| | - Davor Miličić
- Cardiology Clinic, University Hospital Center Zagreb, Zagreb, Croatia
| | - Vedran Premužić
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, Zagreb, Croatia
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Yang B, Hong X, Zhao Z, Liu Y, Zhang H, Feng Z. Positive association between arterial blood lactate level before extra-corporeal membrane oxygenation and 30-day mortality in pediatric patients with severe cardiopulmonary failure. Perfusion 2023:2676591231202369. [PMID: 37699199 DOI: 10.1177/02676591231202369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
INTRODUCTION This study aimed to investigate the relationship between blood lactate level and mortality in pediatric patients receiving extracorporeal membrane oxygenation (ECMO) for severe cardiopulmonary failure. METHODS A retrospective observational study was conducted on pediatric patients who received ECMO from January 2013 to December 2021 at the Seventh Medical Center of PLA General Hospital. Patient demographic characteristics, arterial blood lactate level prior to ECMO (pre-ECMO), ECMO settings, ECMO duration, and 30-days mortality were retrieved from patients' medical records. The relationships between pre-ECMO blood lactate level and mortality were interpreted using the logistic regression analysis and Kaplan-Meier survival analysis. RESULTS A total of 160 pediatric patients who had either refractory respiratory failure (n = 89) or circulatory failure (n = 71) and received ECMO were included in this study. In both the respiratory failure and circulatory failure groups, the non-survivors showed a higher mean pre-ECMO arterial blood lactate level than the survivors. In the respiratory failure group, a pre-ECMO lactate concentration at ≥11.6 mmol/L had a sensitivity of 51% and a specificity of 82% for predicting mortality. In the circulatory failure group, a pre-ECMO lactate concentration at ≥7.2 mmol/L had a sensitivity of 90% and a specificity of 57% for predicting mortality. The Kaplan-Meier survival curves showed that respiratory failure patients with a pre-ECMO lactate level over 11.6 mmol/L or circulatory failure patients with a pre-ECMO lactate level over 7.2 mmol/L had a higher 30-days mortality rate than those with a lower lactate level. CONCLUSIONS High pre-ECMO arterial blood lactate level serves as an independent risk factor for mortality in pediatric patients who receive ECMO for severe cardiopulmonary failure.
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Affiliation(s)
- Baowang Yang
- Pediatric Intensive Care Unit, Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaoyang Hong
- Pediatric Intensive Care Unit, Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhe Zhao
- Pediatric Intensive Care Unit, Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yingyue Liu
- Pediatric Intensive Care Unit, Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Huiling Zhang
- Pediatric Intensive Care Unit, Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhichun Feng
- Pediatric Intensive Care Unit, Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
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Kim AR, Hyun J, Lee SE, Hong JA, Kang PJ, Jung SH, Kim MS. Prognosis of Venoarterial Extracorporeal Membrane Oxygenation in Mixed, Cardiogenic and Septic Shock. ASAIO J 2023; 69:658-664. [PMID: 37018827 DOI: 10.1097/mat.0000000000001933] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Mixed cardiogenic-septic shock (MS), defined as the combination of cardiogenic (CS) and septic (SS) shock, is often encountered in cardiac intensive care units. Herein, the authors compared the impact of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in MS, CS, and SS. Of 1,023 patients who received VA-ECMO from January 2012 to February 2020 at a single center, 211 with pulmonary embolism, hypovolemic shock, aortic dissection, and unknown causes of shock were excluded. The remaining 812 patients were grouped based on the cause of shock at VA-ECMO application: i) MS (n = 246, 30.3%), ii) CS (n = 466, 57.4%), iii) SS (n = 100, 12.3%). The MS group was younger and had lower left ventricular ejection fraction than the CS or SS group did. The 30 day and 1 year mortalities were the highest in SS (30 day mortality: 50.4% vs. 43.3% vs. 69.0%, p < 0.001 for MS versus CS versus SS, respectively; 1 year mortality: 67.5% vs. 53.2% vs. 81.0%, p < 0.001 for MS versus CS versus SS, respectively). Posthoc analysis showed that the 30 day mortality of MS was not different from CS, while the 1 year mortality of MS was worse than CS but better than SS. Venoarterial extracorporeal membrane oxygenation application for MS may help improve survival and should therefore be considered if indicated.
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Affiliation(s)
- Ah-Ram Kim
- From the Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Junho Hyun
- From the Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Eun Lee
- From the Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung Ae Hong
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Pil-Je Kang
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min-Seok Kim
- From the Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Hao T, Jiang Y, Wu C, Li C, Chen C, Xie J, Pan C, Guo F, Huang Y, Liu L, Xie H, Du Z, Hou X, Liu S, Yang Y, Qiu H. Clinical outcome and risk factors for acute fulminant myocarditis supported by venoarterial extracorporeal membrane oxygenation: An analysis of nationwide CSECLS database in China. Int J Cardiol 2023; 371:229-235. [PMID: 36174824 DOI: 10.1016/j.ijcard.2022.09.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 08/04/2022] [Accepted: 09/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND To assess the outcomes and risk factors for adult patients with acute fulminant myocarditis (AFM) supported with venoarterial extracorporeal membrane oxygenation (VA ECMO) in China mainland. METHODS Data were extracted from Chinese Society of ExtraCorporeal Life Support (CSECLS) Registry database. Data from adult patients who were diagnosed with AFM and needed VA ECMO in the database were retrospectively analyzed. The primary outcome was 90-day mortality after ECMO initiation in patients with AFM supported with VA ECMO. Cox proportional hazard regression model was used to examine the risk factors associated with 90-day mortality. RESULTS Among 221 patients enrolled and followed up to 90 days, 186 (84.2%) patients weaned from ECMO and 159 (71.9%) patients survived and discharged home. The median age was 38 years (IQR 29-49) and males (n = 115) represented 52.0% of the total accounted patients. The median ECMO duration was 134 h (IQR 96-177 h). The main adverse event during ECMO course was bleeding (16.3%), followed by infection (15.4%). In the multivariate Cox model analysis, cardiac arrest prior to ECMO initiation (adjusted HR 2.529; 95%CI: 1.341-4.767, p = 0.004), lower pH value (adjusted HR 0.016; 95%CI: 0.010-0.059, p < 0.001) and higher lactate concentration at 24 h after ECMO initiation (adjusted HR 1.146; 95%CI: 1.075-1.221, p < 0.001) were associated with 90-day mortality. CONCLUSIONS 71.9% patients with AFM (clinical diagnosed) supported with VA ECMO survived. Cardiac arrest prior to ECMO, lower pH and higher lactate concentration at 24 h after ECMO initiation were correlated with 90-day mortality of AFM patients supported with VA ECMO.
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Affiliation(s)
- Tong Hao
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, People's Republic of China
| | - Yu Jiang
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Changde Wu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, People's Republic of China
| | - Chenglong Li
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Chuang Chen
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, People's Republic of China
| | - Jianfeng Xie
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, People's Republic of China
| | - Chun Pan
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, People's Republic of China
| | - Fengmei Guo
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, People's Republic of China
| | - Yingzi Huang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, People's Republic of China
| | - Ling Liu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, People's Republic of China
| | - Haixiu Xie
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhongtao Du
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaotong Hou
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Songqiao Liu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, People's Republic of China; Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, No. 86 Chongwen Road, Lishui District, Nanjing 211200, Jiangsu, People's Republic of China.
| | - Yi Yang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, People's Republic of China.
| | - Haibo Qiu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, People's Republic of China
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Rissel R, Koelm S, Schepers M, Dohle DS, Albers J, Oezkur M, Kriege M, Bodenstein M. Elevated lactate levels and impaired lactate clearance during extracorporeal life support (ECLS) are associated with poor outcome in cardiac surgery patients. PLoS One 2022; 17:e0278139. [PMID: 36441698 PMCID: PMC9704663 DOI: 10.1371/journal.pone.0278139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
Abstract
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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Affiliation(s)
- René Rissel
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
- * E-mail:
| | - Sascha Koelm
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Markus Schepers
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Daniel-Sebastian Dohle
- Department of Cardiothoracic and Vascular Surgery, University Hospital of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Joerg Albers
- Department of Cardiothoracic and Vascular Surgery, University Hospital of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mehmet Oezkur
- Department of Cardiothoracic and Vascular Surgery, University Hospital of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marc Kriege
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Marc Bodenstein
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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Kurniawati ER, Teerenstra S, Vranken NPA, Sharma AS, Maessen JG, Weerwind PW. Oxygen debt repayment in the early phase of veno-arterial extracorporeal membrane oxygenation: a cluster analysis. BMC Cardiovasc Disord 2022; 22:363. [PMID: 35941546 PMCID: PMC9358885 DOI: 10.1186/s12872-022-02794-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Early oxygen debt repayment is predictive of successful weaning from veno-arterial extracorporeal membrane oxygenation (V-A ECMO). However, studies are limited by the patient cohort’s heterogeneity. This study aimed to understand the early state of oxygen debt repayment and its association with end-organ failure and 30-day survival using cluster analysis. Methods A retrospective, single-center study was conducted on 153V-A ECMO patients. Patients were clustered using a two-step cluster analysis based on oxygen debt and its repayment during the first 24 h of ECMO. Primary outcomes were end-organ failure and 30-day survival. Results The overall mortality was 69.3%. For cluster analysis, 137 patients were included, due to an incomplete data set. The mortality rate in this subset was 67.9%. Three clusters were generated, representing increasing levels of total oxygen debt from cluster 1 to cluster 3. Thirty-day survival between clusters was significantly different (cluster 1: 46.9%, cluster 2: 23.4%, and cluster 3: 4.8%, p = 0.001). Patients in cluster 3 showed less decrement in liver enzymes, creatinine, and urea blood levels. There were significant differences in the baseline oxygen debt and the need for continuous veno-venous hemofiltration (CVVH) between survivors and non-survivors (p < 0.05). Forty-seven patients (34.3%) migrated between clusters within the first 24 h of support. Among these patients, 43.4% required CVVH. Notably, patients requiring CVVH and who migrated to a cluster with a higher oxygen debt repayment showed better survival rates compared to those who migrated to a cluster with a lower oxygen debt repayment. Conclusions Oxygen debt repayment during the first 24 h of V-A ECMO shows to correspond with survival, where the baseline oxygen debt value and the necessity for continuous kidney replacement therapy appear to be influential.
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Affiliation(s)
- E R Kurniawati
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - S Teerenstra
- Department for Health Evidence, Section Biostatistics, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - N P A Vranken
- Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - A S Sharma
- INA Learning Labs, Bangalore, Karnataka, India
| | - J G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - P W Weerwind
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
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Comparison of lactate/albumin ratio to lactate and lactate clearance for predicting outcomes in patients with septic shock admitted to intensive care unit: an observational study. Sci Rep 2022; 12:13047. [PMID: 35906231 PMCID: PMC9338032 DOI: 10.1038/s41598-022-14764-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 06/13/2022] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to evaluate the prognostic value of the Lactate to Albumin (L/A) ratio compared to that of lactate and lactate clearance in predicting outcomes in patients with septic shock. This was a multi-center observational study of adult patients with septic shock, who admitted to intensive care units (ICUs) at Shohada and Imam Reza Hospitals, Tabriz, Iran, between Sept 2018 and Jan 2021. The area under the curve (AUC) of receiver operating characteristic (ROC) curve and multivariate logistic regression analyses were used to explore associations of the L/A ratio, lactate and lactate clearance on the primary (mortality) and secondary outcomes [ICU length of stay (LOS), duration of mechanical ventilation (MV), need of renal replacement therapy (RRT) and duration of using vasopressors] at baseline, 6 h and 24 h of septic shock recognition. Best performing predictive value for mortality were related to lactate clearance at 24 h, L/A ratio at 6 h and lactate levels at 24 h with (AUC 0.963, 95% CI 0.918-0.987, P < 0.001), (AUC 0.917, 95% CI 0.861-0.956, P < 0.001), and (AUC 0.904, 95% CI 0.845-0.946, P < 0.001), respectively. Generally, the lactate clearance at 24 h had better prognostic performance for mortality and duration of using vasopressor. However, the L/A ratio had better prognostic performance than serum lactate and lactate clearance for RRT, ICU LOS and MV duration.
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Wang Z, Xu J, Kang Y, Liu L, Zhang L, Wang D. Early dynamic behavior of lactate in predicting continuous renal replacement therapy after surgery for acute type A aortic dissection. Front Cardiovasc Med 2022; 9:948672. [PMID: 35958404 PMCID: PMC9360317 DOI: 10.3389/fcvm.2022.948672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundIt has been well known that hyperlactatemia is an independent risk factor for postoperative mortality in patients who received acute type A aortic dissection (ATAAD) surgery. Some patients may require the assistance of continuous renal replacement therapy (CRRT) for acute postoperative renal deficiency and often associate with increased mortality rate. This study aimed to examine the association between the early dynamic change of lactate levels and postoperative CRRT in ATAAD patients who received surgical repairment.MethodsThis retrospective study included 503 patients who received ATAAD surgeries. Serum lactate levels were measured before operation and at 0, 1, 3, 6, 12, 24 h post intensive care unit (ICU) admission. We examined the association between dynamic changes of lactate and CRRT.ResultsAmong all patients, 19.9% (100 patients) required CRRT. Our data showed that the lactate levels were higher in the CRRT group at all timepoints compared to the non-CRRT group. In a multivariate model, lactate levels at 12 h post ICU admission [odds ratio (OR), 1.362; p = 0.007] was identified as an independent predictor for requiring CRRT. Unsurprisingly, 30-day mortality in the CRRT group (41%) was 8.2 times higher than in the non-CRRT group (5%). To better understand the associations between CRRT and lactate levels, patients in the CRRT group were further stratified into the non-survivor group (n = 41) and survivor group (n = 59) based on the 30-day mortality. Elevated lactate levels measured upon ICU admission (OR, 1.284; p = 0.001) and decreased 24 h lactate clearance (OR, 0.237; p = 0.039) were independent risk factors for 30-day mortality in patients who received CRRT. The area under the curve to predict requirement for CRRT at 6 and 12 h post CICU admission were 0.714 and 0.722, respectively, corresponding to lactate cut-off levels of 4.15 and 2.45 mmol/L.ConclusionThe CRRT is commonly required in patients who received ATAAD surgery and often associated with worse mortality. Early dynamic changes of lactate levels can be used to predict the requirement of postoperative CRRT.
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Affiliation(s)
- Zhigang Wang
- Department of Cardio-Thoracic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jingfang Xu
- Department of Nephrology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yubei Kang
- Department of Cardio-Thoracic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ling Liu
- Department of Cardio-Thoracic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Lifang Zhang
- Department of Psychiatry, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Dongjin Wang
- Department of Cardio-Thoracic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
- *Correspondence: Dongjin Wang,
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Martínez-Solano J, Sousa-Casasnovas I, Bellón-Cano JM, García-Carreño J, Juárez-Fernández M, Díez-Delhoyo F, Sanz-Ruiz R, Devesa-Cordero C, Elízaga-Corrales J, Fernández-Avilés F, Martínez-Sellés M. Lactate levels as a prognostic predict in cardiogenic shock under venoarterial extracorporeal membrane oxygenation support. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:595-603. [PMID: 34810119 DOI: 10.1016/j.rec.2021.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/13/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION AND OBJECTIVES Lactate and its evolution are associated with the prognosis of patients in shock, although there is little evidence in those assisted with an extracorporeal venoarterial oxygenation membrane (VA-ECMO). Our objective was to evaluate its prognostic value in cardiogenic shock assisted with VA-ECMO. METHODS Study of patients with cardiogenic shock treated with VA-ECMO for medical indication between July 2013 and April 2021. Lactate clearance was calculated: [(initial lactate - 6 h lactate) / initial lactate × exact time between both determinations]. RESULTS From 121 patients, 44 had acute myocardial infarction (36.4%), 42 implant during cardiopulmonary resuscitation (34.7%), 14 pulmonary embolism (11.6%), 14 arrhythmic storm (11.6%), and 6 fulminant myocarditis (5.0%). After 30 days, 60 patients (49.6%) died, mortality was higher for implant during cardiopulmonary resuscitation than for implant in spontaneous circulation (30 of 42 [71.4%] vs 30 of 79 [38.0%], P=.030). Preimplantation GPT and lactate (both baseline, at 6hours, and clearance) were independently associated with 30-day mortality. The regression models that included lactate clearance had a better predictive capacity for survival than the ENCOURAGE and ECMO-ACCEPTS scores, with the area under the ROC curve being greater in the model with lactate at 6 h. CONCLUSIONS Lactate (at baseline, 6h, and clearance) is an independent predictor of prognosis in patients in cardiogenic shock supported by VA-ECMO, allowing better risk stratification and predictive capacity.
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Affiliation(s)
- Jorge Martínez-Solano
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Iago Sousa-Casasnovas
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - José María Bellón-Cano
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Jorge García-Carreño
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Miriam Juárez-Fernández
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Felipe Díez-Delhoyo
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ricardo Sanz-Ruiz
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Carolina Devesa-Cordero
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Jaime Elízaga-Corrales
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Francisco Fernández-Avilés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, Madrid, Spain.
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20
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Martínez-Solano J, Sousa-Casasnovas I, Bellón-Cano JM, García-Carreño J, Juárez-Fernández M, Díez-Delhoyo F, Sanz-Ruiz R, Devesa-Cordero C, Elízaga-Corrales J, Fernández-Avilés F, Martínez-Sellés M. Cinética del lactato para el pronóstico en el shock cardiogénico asistido con oxigenador extracorpóreo de membrana venoarterial. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Ho CL, Ju TR, Lee CC, Lin HT, Wang AL, Chen RJ, Lin YC. The Early Dynamic Change in Cardiac Enzymes and Renal Function Is Associated with Mortality in Patients with Fulminant Myocarditis on Extracorporeal Membrane Oxygenation: Analysis of a Single Center's Experience. Healthcare (Basel) 2022; 10:1063. [PMID: 35742115 PMCID: PMC9222735 DOI: 10.3390/healthcare10061063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
Abstract
(1) Background: Fulminant myocarditis (FM) could result in hemodynamic derangement and fatal arrhythmia. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is used to maintain organ perfusion in FM patients complicating cardiogenic shock. The present study aims to assess the static and dynamic factors in association with mortality in FM patients on V-A ECMO (2) Methods: Twenty-eight patients were enrolled between 2013 to 2019 for analysis (3) Results: In-hospital survival rate was 78.5%. There was no statistical difference in demographics and baseline laboratory data between survivors and non-survivors. However, within 24 h after ECMO support, CK-MB increased by 96.8% among non-survivors, but decreased by 23.7% among survivors (p = 0.022). Troponin I increased by 378% among non-survivors and 1.7% among survivors (p = 0.032). Serum creatinine increased by 108% among non-survivors, but decreased by 8.5% among survivors (p = 0.005). The receiver operating characteristic curve suggested an increase in serum creatinine by 68% within 24 h after ECMO support was associated with increased mortality with an area under the curve of 0.91. (4) Conclusions: V-A ECMO is an excellent tool to support FM patients with cardiogenic shock. The early dynamic change of renal function and cardiac enzymes may be useful for outcome assessment.
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Affiliation(s)
- Ching-Lin Ho
- Department of Surgery, Division of Cardiovascular Surgery, China Medical University Hospital, Taichung City 406040, Taiwan;
| | - Teressa Reanne Ju
- Department of Internal Medicine, New York Presbyterian Queens, New York, NY 11355, USA;
| | - Chi Chan Lee
- Department of Critical Care, Guam Regional Medical City, Tamuning, GU 96929, USA;
| | - Hsin-Ti Lin
- College of Medicine, China Medical University, Taichung City 406040, Taiwan; (H.-T.L.); (A.-L.W.)
| | - Alexander-Lee Wang
- College of Medicine, China Medical University, Taichung City 406040, Taiwan; (H.-T.L.); (A.-L.W.)
| | - Robert Jeenchen Chen
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, USA;
| | - You-Cian Lin
- Department of Surgery, Division of Cardiovascular Surgery, China Medical University Hospital, Taichung City 406040, Taiwan;
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22
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Krychtiuk KA, Vrints C, Wojta J, Huber K, Speidl WS. Basic mechanisms in cardiogenic shock: part 2 - biomarkers and treatment options. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:366-374. [PMID: 35218355 DOI: 10.1093/ehjacc/zuac022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/02/2022] [Accepted: 02/11/2022] [Indexed: 06/14/2023]
Abstract
Cardiogenic shock mortality rates remain high despite significant advances in cardiovascular medicine and the widespread uptake of mechanical circulatory support systems. Except for early invasive angiography and percutaneous coronary intervention of the infarct-related artery, all other widely used therapeutic measures are based on low-quality evidence. The grim prognosis and lack of high-quality data warrant further action. Within Part 2 of this two-part educational review on basic mechanisms in cardiogenic shock, we aimed to highlight the current status of translating our understanding of the pathophysiology of cardiogenic shock into clinical practice. We summarize the current status of biomarker research in risk stratification and therapy guidance. In addition, we summarized the current status of translating the findings from bench-, bedside, and biomarker studies into treatment options. Several large randomized controlled trials (RCTs) are underway, providing a huge opportunity to study contemporary cardiogenic shock patients. Finally, we call for translational, homogenous, biomarker-based, international RCTs testing novel treatment approaches to improve the outcome of our patients.
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Affiliation(s)
- Konstantin A Krychtiuk
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- Duke Clinical Research Institute, 300 W Morgan Street, 27701 Durham, NC, USA
| | - Christiaan Vrints
- Research Group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Prinsstraat 13, 2000 Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Johann Wojta
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Waehringer Guertel 18-20, 1090 Vienna, Austria
- Core Facilities, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Kurt Huber
- Ludwig Boltzmann Institute for Cardiovascular Research, Waehringer Guertel 18-20, 1090 Vienna, Austria
- 3rd Department of Internal Medicine, Cardiology and Intensive Care Unit, Wilhelminenhospital, Montleartstraße 37, 1160 Vienna, Austria
- Medical School, Sigmund Freud University, Freudplatz 1, 1020 Vienna, Austria
| | - Walter S Speidl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Waehringer Guertel 18-20, 1090 Vienna, Austria
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23
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Marbach JA, Di Santo P, Kapur NK, Thayer KL, Simard T, Jung RG, Parlow S, Abdel-Razek O, Fernando SM, Labinaz M, Froeschl M, Mathew R, Hibbert B. Lactate Clearance as a Surrogate for Mortality in Cardiogenic Shock: Insights From the DOREMI Trial. J Am Heart Assoc 2022; 11:e023322. [PMID: 35261289 PMCID: PMC9075306 DOI: 10.1161/jaha.121.023322] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Recent studies have shown improved outcomes in cardiogenic shock through protocols directed toward early identification and initiation of mechanical circulatory support. However, objective therapeutic targets—based on clinical and/or laboratory data—to guide real‐time clinical decision making are lacking. Lactate clearance has been suggested as a potential treatment target because of its independent association with mortality. Methods and Results In a post hoc analysis of the DOREMI (Dobutamine Compared to Milrinone in the Treatment of Cardiogenic Shock) trial—a randomized, double‐blind, controlled trial comparing milrinone to dobutamine in the treatment of cardiogenic shock—we used prospectively collected lactate data to evaluate lactate clearance as a surrogate marker for in‐hospital mortality. In total, 82 (57.7%) patients survived to hospital discharge (survivors). In multivariate logistic regression analysis, complete lactate clearance, percentage lactate clearance, and percentage lactate clearance per hour were independently associated with survival beginning as early as 8 hours after enrollment. Complete lactate clearance was the strongest predictor of survival at all time points, with odds ratios ranging between 2.46 (95% CI, 1.09–5.55; P=0.03) at 8 hours to 5.44 (95% CI, 2.14–13.8; P<0.01) at 24 hours. Conclusions Complete lactate clearance is a strong and independent predictor of in‐hospital survival in patients with cardiogenic shock. Together with previously published data, these results further support the validity of lactate clearance as an appropriate surrogate for mortality and as a potential therapeutic target in future cardiogenic shock trials. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03207165.
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Affiliation(s)
- Jeffrey A Marbach
- CAPITAL Research Group Division of Cardiology Department of Medicine University of Ottawa Heart Institute Ottawa Canada.,Division of Pulmonary Critical Care and Sleep Medicine Tufts Medical Center and Tufts University School of Medicine Boston MA.,Division of Cardiology Beth Israel Deaconess Medical Center Boston MA
| | - Pietro Di Santo
- CAPITAL Research Group Division of Cardiology Department of Medicine University of Ottawa Heart Institute Ottawa Canada.,Faculty of Medicine University of Ottawa Canada.,School of Epidemiology and Public Health University of Ottawa Canada
| | - Navin K Kapur
- Department of Medicine Tufts Medical Center and Tufts University School of Medicine Boston MA.,The Cardiovascular Center Tufts Medical Center and Tufts University School of Medicine Boston MA
| | - Katherine L Thayer
- The Cardiovascular Center Tufts Medical Center and Tufts University School of Medicine Boston MA
| | - Trevor Simard
- CAPITAL Research Group Division of Cardiology Department of Medicine University of Ottawa Heart Institute Ottawa Canada.,Division of Cardiology Mayo Clinic Rochester MN
| | - Richard G Jung
- CAPITAL Research Group Division of Cardiology Department of Medicine University of Ottawa Heart Institute Ottawa Canada.,Faculty of Medicine University of Ottawa Canada.,Department of Cellular and Molecular Medicine University of Ottawa Canada
| | - Simon Parlow
- CAPITAL Research Group Division of Cardiology Department of Medicine University of Ottawa Heart Institute Ottawa Canada.,Faculty of Medicine University of Ottawa Canada
| | - Omar Abdel-Razek
- CAPITAL Research Group Division of Cardiology Department of Medicine University of Ottawa Heart Institute Ottawa Canada.,Faculty of Medicine University of Ottawa Canada
| | - Shannon M Fernando
- Faculty of Medicine University of Ottawa Canada.,Division of Critical Care Department of Medicine University of Ottawa Canada
| | - Marino Labinaz
- CAPITAL Research Group Division of Cardiology Department of Medicine University of Ottawa Heart Institute Ottawa Canada.,Faculty of Medicine University of Ottawa Canada
| | - Michael Froeschl
- CAPITAL Research Group Division of Cardiology Department of Medicine University of Ottawa Heart Institute Ottawa Canada.,Faculty of Medicine University of Ottawa Canada
| | - Rebecca Mathew
- CAPITAL Research Group Division of Cardiology Department of Medicine University of Ottawa Heart Institute Ottawa Canada.,Faculty of Medicine University of Ottawa Canada.,Division of Critical Care Department of Medicine University of Ottawa Canada
| | - Benjamin Hibbert
- CAPITAL Research Group Division of Cardiology Department of Medicine University of Ottawa Heart Institute Ottawa Canada.,Faculty of Medicine University of Ottawa Canada.,Department of Cellular and Molecular Medicine University of Ottawa Canada
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24
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Gonzales Carazas MM, Gavidia CM, Davila Fernandez R, Vargas Zuñiga JA, Crespo Paiva A, Bocanegra W, Calderon J, Sanchez E, Perales R, Zeña B, Calcina Isique JF, Reategui J, Castañeda B, Casado FL. Biological evaluation of a mechanical ventilator that operates by controlling an automated manual resuscitator. A descriptive study in swine. PLoS One 2022; 17:e0264774. [PMID: 35239740 PMCID: PMC8893637 DOI: 10.1371/journal.pone.0264774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/17/2022] [Indexed: 11/26/2022] Open
Abstract
The Covid-19 outbreak challenged health systems around the world to design and implement cost-effective devices produced locally to meet the increased demand of mechanical ventilators worldwide. This study evaluates the physiological responses of healthy swine maintained under volume- or pressure-controlled mechanical ventilation by a mechanical ventilator implemented to bring life-support by automating a resuscitation bag and closely controlling ventilatory parameters. Physiological parameters were monitored in eight sedated animals (t0) prior to inducing deep anaesthesia, and during the next six hours of mechanical ventilation (t1-7). Hemodynamic conditions were monitored periodically using a portable gas analyser machine (i.e. BEecf, carbonate, SaO2, lactate, pH, PaO2, PaCO2) and a capnometer (i.e. ETCO2). Electrocardiogram, echocardiography and lung ultrasonography were performed to detect in vivo alterations in these vital organs and pathological findings from necropsy were reported. The mechanical ventilator properly controlled physiological levels of blood biochemistry such as oxygenation parameters (PaO2, PaCO2, SaO2, ETCO2), acid-base equilibrium (pH, carbonate, BEecf), and perfusion of tissues (lactate levels). In addition, histopathological analysis showed no evidence of acute tissue damage in lung, heart, liver, kidney, or brain. All animals were able to breathe spontaneously after undergoing mechanical ventilation. These preclinical data, supports the biological safety of the medical device to move forward to further evaluation in clinical studies.
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Affiliation(s)
| | - Cesar Miguel Gavidia
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | | | | | - William Bocanegra
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Joan Calderon
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Evelyn Sanchez
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Rosa Perales
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Brandon Zeña
- Instituto Veterinario de Oftalmologia (IVO), Lima, Peru
| | | | | | - Benjamin Castañeda
- Institute of Omics and Applied Biotechnology, Pontificia Universidad Catolica del Peru, Lima, Peru
- Department of Engineering, Pontificia Universidad Catolica del Peru, Lima, Peru
| | - Fanny L. Casado
- Institute of Omics and Applied Biotechnology, Pontificia Universidad Catolica del Peru, Lima, Peru
- Department of Engineering, Pontificia Universidad Catolica del Peru, Lima, Peru
- * E-mail:
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25
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Kim E, Sodirzhon-Ugli NY, Kim DW, Lee KS, Lim Y, Kim MC, Cho YS, Jung YH, Jeung KW, Cho HJ, Jeong IS. Prediction of 6-Month Mortality Using Pre-Extracorporeal Membrane Oxygenation Lactate in Patients with Acute Coronary Syndrome Undergoing Veno-Arterial-Extracorporeal Membrane Oxygenation. J Chest Surg 2022; 55:143-150. [PMID: 35232896 PMCID: PMC9005935 DOI: 10.5090/jcs.21.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/15/2021] [Accepted: 12/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background The effectiveness of extracorporeal membrane oxygenation (ECMO) for patients with refractory cardiogenic shock or cardiac arrest is being established, and serum lactate is well known as a biomarker of end-organ perfusion. We evaluated the efficacy of pre-ECMO lactate for predicting 6-month survival in patients with acute coronary syndrome (ACS) undergoing ECMO. Methods We reviewed the medical records of 148 patients who underwent veno-arterial (VA) ECMO for ACS between January 2015 and June 2020. These patients were divided into survivors and non-survivors based on 6-month survival. All clinical data before and during ECMO were compared between the 2 groups. Results Patients’ mean age was 66.0±10.5 years, and 116 (78.4%) were men. The total survival rate was 45.9% (n=68). Cox regression analysis showed that the pre-ECMO lactate level was an independent predictor of 6-month mortality (hazard ratio, 1.210; 95% confidence interval [CI], 1.064–1.376; p=0.004). The area under the receiver operating characteristic curve of pre-ECMO lactate was 0.64 (95% CI, 0.56–0.72; p=0.002; cut-off value=9.8 mmol/L). Kaplan-Meier survival analysis showed that the cumulative survival rate at 6 months was significantly higher among patients with a pre-ECMO lactate level of 9.8 mmol/L or less than among those with a level exceeding 9.8 mmol/L (57.3% vs. 31.8%, p=0.0008). Conclusion A pre-ECMO lactate of 9.8 mmol/L or less may predict a favorable outcome at 6 months in ACS patients undergoing VA-ECMO. Further research aiming to improve the accuracy of predictions of reversibility in patients with high pre-ECMO lactate levels is essential.
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Affiliation(s)
- Eunchong Kim
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Nodirbek Yuldashev Sodirzhon-Ugli
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Do Wan Kim
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Kyo Seon Lee
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Yonghwan Lim
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
| | - Min-Chul Kim
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
| | - Yong Soo Cho
- Department of Emergency, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Yong Hun Jung
- Department of Emergency, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Woon Jeung
- Department of Emergency, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Hwa Jin Cho
- Department of Pediatrics, Chonnam National University Children's Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - In Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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26
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Kurniawati ER, van Kuijk SMJ, Vranken NPA, Maessen JG, Weerwind PW. Efficacy of Veno-Arterial Extracorporeal Life Support in Adult Patients with Refractory Cardiogenic Shock. CLINICAL MEDICINE INSIGHTS: CIRCULATORY, RESPIRATORY AND PULMONARY MEDICINE 2022; 16:11795484221113988. [PMID: 35899243 PMCID: PMC9309772 DOI: 10.1177/11795484221113988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background This study aimed to describe the efficacy of veno-arterial extracorporeal
life support (VA-ECLS) through early lactate clearance and pH restoration
and assess the potential association with 30-day survival following hospital
discharge. Methods Data of patients receiving VA-ECLS for at least 24 h were retrospectively
compiled. Blood lactate levels, liver enzymes, and kidney parameters prior
to VA-ECLS initiation and at 2, 8, 14, 20, and 26 h of support had been
recorded as part of clinical care. The primary outcome was 30-day
survival. Results Of 77 patients who underwent VA-ECLS for refractory cardiogenic shock, 44.2%
survived. For all non-survivors, ECLS was initiated after eight hours
(p = .008). Blood pH was significantly higher in
survivors compared to non-survivors at all time points except for pre-ECLS.
Lactate levels were significantly lower in survivors (median range 1.95-4.70
vs 2.90-6.70 mmol/L for survivors vs non-survivors, respectively).
Univariate and multivariate analyses indicated that blood pH at 24 h (OR
0.045, 95% CI: 0.005-0.448 for pH <7.35, p = .045) and
lactate concentration pre-ECLS (OR 0.743, 95% CI: 0.590-0.936,
p = .012) were reliable predictors for 30-day survival.
Further, ischemic cardiogenic shock as ECLS indication showed 36.2% less
lactate clearance compared to patients with other indications such as
arrhythmia, postcardiotomy, and ECPR. Conclusion ECLS showed to be an effective treatment in reducing blood lactate levels in
patients suffering from refractory cardiogenic shock in which the outcome is
influenced by the initial lactate level and pH in the early phase of the
intervention.
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Affiliation(s)
- ER Kurniawati
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - SMJ van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - NPA Vranken
- Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - JG Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - PW Weerwind
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
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27
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Lassus J, Tarvasmäki T, Tolppanen H. Biomarkers in cardiogenic shock. Adv Clin Chem 2022; 109:31-73. [DOI: 10.1016/bs.acc.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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28
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Omar HR, Handshoe JW, Tribble T, Guglin M. Survival on Venoarterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock: Which Lactate Is Most Useful? ASAIO J 2022; 68:41-45. [PMID: 33769350 DOI: 10.1097/mat.0000000000001413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Prognostic significance of elevated serum lactate in patients on venoarterial extracorporeal membrane oxygenation (ECMO) is widely known. Our objective was to study the utility of lactate measured at different points of time and lactate clearance in predicting the two study endpoints: successful ECMO weaning and hospital survival. Among 238 consecutive patients treated with ECMO, lactic acid was collected before initiating ECMO and then on days 1, 3, 5, and 10 while on ECMO. Out of our cohort, 129 (54.2%) were successfully weaned and 98 (41.2%) were discharged alive. Patients successfully weaned from ECMO had a significantly lower lactic acid level pre-ECMO (p = 0.001), at day 1 (p < 0.001), day 3 (p < 0.001), and day 5 (p = 0.001), compared with unsuccessfully weaned patients. Also, patients who survived hospitalization had significantly lower lactic acid pre-ECMO (p = 0.007), at day 1 (p < 0.001), day 3 (p = 0.001), and day 5 (p = 0.001), compared with those who died in-hospital. With regard to hospital survival, day 3 lactic acid was superior to pre-ECMO lactic acid (p = 0.0385), lactic acid on day 1, lactic acid reduction from pre-ECMO to day 1 (p = 0.0177) and from pre-ECMO to day 3 (p = 0.0361), and a day 3 lactic acid ≤ 1.7 meq/L was the optimal value that predicted hospital survival. On multivariable analysis, day 3 lactic acid independently predicted hospital survival after covariate adjustment (odds ratio [OR], 0.505; 95% confidence interval [CI], 0.290-0.880; p = 0.016). In conclusion, the absolute level of lactic acid while on ECMO support is more important for prognosis than a pre-ECMO level or the magnitude of decline from pre-ECMO to on-ECMO.
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Affiliation(s)
- Hesham R Omar
- From the Internal Medicine Physician at Online Care Group, Chicago, Illinois
| | | | - Thomas Tribble
- University of Kentucky College of Medicine, Lexington, Kentucky
| | - Maya Guglin
- Division of Cardiology, Krannert Institute of Cardiology, Indiana University, Indianapolis, Indiana
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Park IH, Cho HK, Oh JH, Chun WJ, Park YH, Lee M, Kim MS, Choi KH, Kim J, Song YB, Hahn JY, Choi SH, Lee SC, Gwon HC, Choe YH, Jang WJ. Clinical Significance of Serum Lactate in Acute Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study. J Clin Med 2021; 10:jcm10225278. [PMID: 34830561 PMCID: PMC8618836 DOI: 10.3390/jcm10225278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 01/18/2023] Open
Abstract
Little is known about causality and the pathological mechanism underlying the association of serum lactate with myocardial injury in patients with acute myocardial infarction (AMI). We evaluated data from 360 AMI patients undergoing percutaneous coronary intervention (PCI) using cardiovascular magnetic resonance imaging (CMR). Of these, 119 patients had serum lactate levels > 2.5 mmol/L on admission (high serum lactate group), whereas 241 patients had serum lactate levels ≤ 2.5 mmol/L (low serum lactate group). We compared the myocardial infarct size assessed by CMR between the two groups and performed inverse probability of treatment weighting (IPTW). In CMR analysis, myocardial infarct size was significantly greater in the high serum lactate group than in the low serum lactate group (22.0 ± 11.4% in the high serum lactate group vs. 18.9 ± 10.5% in the low serum lactate group; p = 0.011). The result was consistent after IPTW adjustment (21.5 ± 11.1% vs. 19.2 ± 10.4%; p = 0.044). In multivariate analysis, high serum lactate was associated with larger myocardial infarct (odds ratio 1.59; 95% confidence interval 1.00–2.51; p = 0.048). High serum lactate could predict advanced myocardial injury in AMI patients undergoing PCI.
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Affiliation(s)
- Ik Hyun Park
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea; (I.H.P.); (H.K.C.); (J.H.O.); (W.J.C.); (Y.H.P.); (M.L.); (M.S.K.)
| | - Hyun Kyu Cho
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea; (I.H.P.); (H.K.C.); (J.H.O.); (W.J.C.); (Y.H.P.); (M.L.); (M.S.K.)
| | - Ju Hyeon Oh
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea; (I.H.P.); (H.K.C.); (J.H.O.); (W.J.C.); (Y.H.P.); (M.L.); (M.S.K.)
| | - Woo Jung Chun
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea; (I.H.P.); (H.K.C.); (J.H.O.); (W.J.C.); (Y.H.P.); (M.L.); (M.S.K.)
| | - Yong Hwan Park
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea; (I.H.P.); (H.K.C.); (J.H.O.); (W.J.C.); (Y.H.P.); (M.L.); (M.S.K.)
| | - Mirae Lee
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea; (I.H.P.); (H.K.C.); (J.H.O.); (W.J.C.); (Y.H.P.); (M.L.); (M.S.K.)
| | - Min Sun Kim
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea; (I.H.P.); (H.K.C.); (J.H.O.); (W.J.C.); (Y.H.P.); (M.L.); (M.S.K.)
| | - Ki Hong Choi
- Samsung Medical Center, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (K.H.C.); (J.K.); (Y.B.S.); (J.-Y.H.); (S.-H.C.); (S.-C.L.); (H.-C.G.)
| | - Jihoon Kim
- Samsung Medical Center, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (K.H.C.); (J.K.); (Y.B.S.); (J.-Y.H.); (S.-H.C.); (S.-C.L.); (H.-C.G.)
| | - Young Bin Song
- Samsung Medical Center, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (K.H.C.); (J.K.); (Y.B.S.); (J.-Y.H.); (S.-H.C.); (S.-C.L.); (H.-C.G.)
| | - Joo-Yong Hahn
- Samsung Medical Center, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (K.H.C.); (J.K.); (Y.B.S.); (J.-Y.H.); (S.-H.C.); (S.-C.L.); (H.-C.G.)
| | - Seung-Hyuk Choi
- Samsung Medical Center, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (K.H.C.); (J.K.); (Y.B.S.); (J.-Y.H.); (S.-H.C.); (S.-C.L.); (H.-C.G.)
| | - Sang-Chol Lee
- Samsung Medical Center, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (K.H.C.); (J.K.); (Y.B.S.); (J.-Y.H.); (S.-H.C.); (S.-C.L.); (H.-C.G.)
| | - Hyeon-Cheol Gwon
- Samsung Medical Center, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (K.H.C.); (J.K.); (Y.B.S.); (J.-Y.H.); (S.-H.C.); (S.-C.L.); (H.-C.G.)
| | - Yeon Hyeon Choe
- Department of Radiology, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Woo Jin Jang
- Division of Cardiology, Department of Internal Medicine, Seoul Hospital, Ewha Womans University College of Medicine, Seoul 07804, Korea
- Correspondence: ; Tel./Fax: +82-2-6986-3320
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Park IH, Yang JH, Jang WJ, Chun WJ, Oh JH, Park YH, Ko YG, Yu CW, Kim BS, Kim HJ, Lee HJ, Jeong JO, Gwon HC. Clinical significance of lactate clearance in patients with cardiogenic shock: results from the RESCUE registry. J Intensive Care 2021; 9:63. [PMID: 34663479 PMCID: PMC8522140 DOI: 10.1186/s40560-021-00571-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/02/2021] [Indexed: 12/22/2022] Open
Abstract
Background Limited data are available on the clinical significance of lactate clearance (LC) in patients with cardiogenic shock (CS). This study investigated the prognostic role of LC in CS patients. Methods We analyzed data from 628 patients in the RESCUE registry, a multicenter, observational cohort enrolled between January 2014 and December 2018. Univariable logistic regression analysis was performed to determine the prognostic implications of 24 h LC, and then patients were divided into two groups according to the cut-off value of 24 h LC (high lactate clearance [HLC] group vs. low lactate clearance [LLC] group). The primary outcome was in-hospital mortality. We also assessed all-cause mortality at 12 month follow-up and compared the prognostic performance of 24 h LC according to initial serum lactate level. Results In the univariable logistic regression analysis, 24 h LC was associated with in-hospital mortality (odds ratio 0.989, 95% confidence interval [CI] 0.985–0.993, p < 0.001), and the cut-off value for the LC of the study population was 64%. The HLC group (initial 24 h LC ≥ 64%, n = 333) had a significantly lower incidence of in-hospital death than the LLC group (n = 295) (25.5% in the HLC group vs. 42.7% in the LLC group, p < 0.001). During 12 months of follow-up, the cumulative incidence of all-cause death was significantly lower in the HLC group than in the LLC group (33.0% vs. 48.8%; hazard ratio 0.55; 95% CI 0.42–0.70; p < 0.001). In subgroup analysis, 24 h LC predicted in-hospital mortality better in patients with initial serum lactate > 5 mmol/L than in those with serum lactate ≤ 5 mmol/L (c-statistics of initial serum lactate > 5 mmol/L = 0.782 vs. c-statistics of initial serum lactate ≤ 5 mmol/L = 0.660, p = 0.011). Conclusions Higher LC during the early phase of CS was associated with reduced risk of in-hospital and 12 month all-cause mortalities. Patients with LC ≥ 64% during the 24 h after CS onset could expect a favorable prognosis, especially those with an initial serum lactate > 5 mmol/L. Trial registration: RESCUE (REtrospective and prospective observational Study to investigate Clinical oUtcomes and Efficacy of left ventricular assist device for Korean patients with cardiogenic shock), NCT02985008, Registered December 5, 2016—retrospectively and prospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT02985008 Supplementary Information The online version contains supplementary material available at 10.1186/s40560-021-00571-7.
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Affiliation(s)
- Ik Hyun Park
- Division of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woo Jin Jang
- Division of Cardiology, Department of Internal Medicine, Seoul Hospital, Ewha Womans University College of Medicine, 260, Gonghang-daero, Gangseo-gu, 07804, Seoul, Republic of Korea.
| | - Woo Jung Chun
- Division of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Ju Hyeon Oh
- Division of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Yong Hwan Park
- Division of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Cheol Woong Yu
- Division of Cardiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Bum Sung Kim
- Division of Cardiology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Hyun-Joong Kim
- Division of Cardiology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Hyun Jong Lee
- Division of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Boeken U, Assmann A, Beckmann A, Schmid C, Werdan K, Michels G, Miera O, Schmidt F, Klotz S, Starck C, Pilarczyk K, Rastan A, Burckhardt M, Nothacker M, Muellenbach R, Zausig Y, Haake N, Groesdonk H, Ferrari M, Buerke M, Hennersdorf M, Rosenberg M, Schaible T, Köditz H, Kluge S, Janssens U, Lubnow M, Flemmer A, Herber-Jonat S, Wessel L, Buchwald D, Maier S, Krüger L, Fründ A, Jaksties R, Fischer S, Wiebe K, Hartog CS, Dzemali O, Zimpfer D, Ruttmann-Ulmer E, Schlensak C, Kelm M, Ensminger S. S3 Guideline of Extracorporeal Circulation (ECLS/ECMO) for Cardiocirculatory Failure. Thorac Cardiovasc Surg 2021; 69:S121-S212. [PMID: 34655070 DOI: 10.1055/s-0041-1735490] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Udo Boeken
- Department of Cardiac Surgery, Heinrich-Heine-University Medical School, Duesseldorf, Germany
| | - Alexander Assmann
- Department of Cardiac Surgery, Heinrich-Heine-University Medical School, Duesseldorf, Germany
| | - Andreas Beckmann
- German Society for Thoracic and Cardiovascular Surgery, Langenbeck-Virchow-Haus, Berlin, Germany
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Karl Werdan
- Clinic for Internal Medicine III, University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg, Germany
| | - Guido Michels
- Department of Acute and Emergency Care, St Antonius Hospital Eschweiler, Eschweiler, Germany
| | - Oliver Miera
- Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Florian Schmidt
- Department of Pediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Hannover, Germany
| | - Stefan Klotz
- Department of Cardiac Surgery, Segeberger Kliniken, Bad Segeberg, Germany
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Centre, Berlin, German
| | - Kevin Pilarczyk
- Department for Intensive Care Medicine, Imland Hospital Rendsburg, Rendsburg, Schleswig-Holstein, Germany
| | - Ardawan Rastan
- Department of Cardiac and Vascular Thoracic Surgery, Philipps-University Hospital Marburg, Marburg, Germany
| | - Marion Burckhardt
- Department of Health Sciences and Management; Baden-Wuerttemberg Cooperative State University (DHBW), Stuttgart, Germany
| | - Monika Nothacker
- Institute for Medical Knowledge Management, Association of the Scientific Medical Societies (AWMF), Universität Marburg, Marburg, Germany
| | - Ralf Muellenbach
- Department of Anaesthesiology and Critical Care Medicine, Campus Kassel of the University of Southampton, Kassel, Germany
| | - York Zausig
- Department of Anesthesiology and Operative Intensive Care Medicine, Aschaffenburg-Alzenau Hospital, Aschaffenburg, Bavaria, Germany
| | - Nils Haake
- Department for Intensive Care Medicine, Imland Hospital Rendsburg, Rendsburg, Schleswig-Holstein, Germany
| | - Heinrich Groesdonk
- Department of Intensive Care Medicine, Helios Clinic Erfurt, Erfurt, Germany
| | - Markus Ferrari
- HSK, Clinic of Internal Medicine I, Helios-Kliniken, Wiesbaden, Germany
| | - Michael Buerke
- Department of Cardiology, Angiology and Intensive Care Medicine, St. Marienkrankenhaus Siegen, Siegen, Germany
| | - Marcus Hennersdorf
- Department of Cardiology, Pneumology, Angiology and Internal Intensive Care Medicine, SLK-Kliniken Heilbronn, Heilbronn, Germany
| | - Mark Rosenberg
- Klinikum Aschaffenburg-Alzenau, Medizinische Klinik 1, Aschaffenburg, Germany
| | - Thomas Schaible
- Department of Neonatology, University Children's Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Harald Köditz
- Medical University Children's Hospital, Hannover, Germany
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Uwe Janssens
- Medical Clinic and Medical Intensive Care Medicine, St Antonius Hospital, Eschweiler, Germany
| | - Matthias Lubnow
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Andreas Flemmer
- Division of Neonatology, Dr. v. Hauner Children's Hospital and Perinatal Center Munich - Grosshadern, LMU Munich, Munich, Germany
| | - Susanne Herber-Jonat
- Division of Neonatology, Dr. v. Hauner Children's Hospital and Perinatal Center Munich - Grosshadern, LMU Munich, Germany
| | - Lucas Wessel
- Department of Pediatric Surgery, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Dirk Buchwald
- Department of Pediatric Surgery, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Sven Maier
- Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany
| | - Lars Krüger
- Division of Thoracic and Cardiovascular Surgery, Heart- and Diabetescentre NRW, Ruhr-University, Bochum, Germany
| | - Andreas Fründ
- Department of Physiotherapy, Heart- and Diabetescentre NRW, Ruhr-University, Bochum, Germany
| | | | - Stefan Fischer
- Department of Thoracic Surgery and Lung Support, Ibbenbueren General Hospital, Ibbenbueren, Germany
| | - Karsten Wiebe
- Department of Cardiothoracic Surgery, Münster University Hospital, Münster, Germany
| | - Christiane S Hartog
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité Universitätsmedizin Berlin, and Klinik Bavaria, Kreischa
| | - Omer Dzemali
- Department of Cardiac Surgery, Triemli City hospital Zurich, Zurich, Switzerland
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Christian Schlensak
- Department of Cardio-Thoracic and Vascular Surgery, University of Tübingen, Tübingen, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Medical School, Duesseldorf, Germany
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein, Lübeck, Germany
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Trahanas JM, Li SS, Crowley JC, Ton VK, Funamoto M, Cudemus Deseda GA, Villavicencio MA, D'Alessandro DA. How to Turn It Down: The Evidence and Opinions Behind Adult Venoarterial Extracorporeal Membrane Oxygenation Weaning. ASAIO J 2021; 67:964-972. [PMID: 34477569 DOI: 10.1097/mat.0000000000001375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Adequate and durable recovery in patients supported with venoarterial (VA) extracorporeal membrane oxygenation (ECMO) can be challenging to predict. Extracorporeal membrane oxygenation weaning is the process by which the ECMO flows are decreased to assess if a patient is ready for decannulation. The optimal strategies for deciding who to wean and how to wean VA ECMO remain undefined. A retrospective literature review was performed to understand the evidence supporting current practices in ECMO weaning and in particular patient selection and methods. Most published work and expert opinions agree that once the underlying process has resolved, the minimum required physiologic parameters for weaning from ECMO include: hemodynamic stability and cardiac pulsatility, adequate lung function to support oxygenation and ventilation, and evidence of recovered end organ function. Echocardiography is universally used to assess cardiac function during the weaning process. Currently, there is no consensus regarding who is eligible to wean or how to wean ECMO in adults. We have reviewed the literature to summarize the evidence and expert opinions behind VA ECMO weaning, and give an example of the protocol used at our center. We believe this protocol optimizes patient selection for weaning and helps to predict successful decannulation.
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Affiliation(s)
- John M Trahanas
- From the Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Selena S Li
- From the Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Jerome C Crowley
- Department of Anesthesia, Division of Critical Care and Pain Management, Massachusetts General Hospital, Boston, Massachusetts
| | - Van-Khue Ton
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Masaki Funamoto
- From the Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Gaston A Cudemus Deseda
- Department of Anesthesia, Division of Critical Care and Pain Management, Massachusetts General Hospital, Boston, Massachusetts
| | - Mauricio A Villavicencio
- From the Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - David A D'Alessandro
- From the Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Kalampokas N, Sipahi NF, Aubin H, Akhyari P, Petrov G, Albert A, Westenfeld R, Lichtenberg A, Saeed D. Postcardiotomy Veno-Arterial Extracorporeal Membrane Oxygenation: Does the Cannulation Technique Influence the Outcome? Front Cardiovasc Med 2021; 8:658412. [PMID: 34434969 PMCID: PMC8382236 DOI: 10.3389/fcvm.2021.658412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/23/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) may be cannulated using either central (cannulation of aorta) or peripheral (cannulation of femoral or axillary artery) access. The ideal cannulation approach for postcardiotomy cardiogenic shock (PCS) is still unknown. The aim of this study is to compare the outcome of patients with PCS who were supported with central vs. peripheral cannulation. Methods: This is a single-center retrospective data analysis including all VA-ECMO implantations for PCS from January 2011 to December 2017. The central and peripheral approaches were compared in terms of patient characteristics, intensive care unit (ICU) stay, hospitalization length, adverse event rates, and overall survival. Results: Eighty-six patients met the inclusion criteria. Twenty-eight patients (33%) were cannulated using the central approach, and 58 patients (67%) were cannulated using the peripheral approach. Forty-three patients (50%) received VA-ECMO in the operating room and 43 patients (50%) received VA-ECMO in the ICU. Central VA-ECMO group had higher EuroSCORE II (p = 0.007), longer cross-clamp time (p = 0.054), higher rate of open chest after the procedure (p < 0.001), and higher mortality rate (p = 0.02). After propensity score matching, 20 patients in each group were reanalyzed. In the matched groups, no statistically significant differences were observed in the baseline characteristics between the two groups except for a higher rate of open chests in the central ECMO group (p = 0.02). However, no significant differences were observed in the outcome and complications between the groups. Conclusions: This study showed that in postcardiotomy patients requiring VA-ECMO support, similar complication rates and outcome were observed regardless of the cannulation strategy.
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Affiliation(s)
- Nikolaos Kalampokas
- Department of Cardiovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Nihat Firat Sipahi
- Department of Cardiovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Hug Aubin
- Department of Cardiovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Payam Akhyari
- Department of Cardiovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Georgi Petrov
- Department of Cardiovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Alexander Albert
- Department of Cardiovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Diyar Saeed
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
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Fuernau G, Desch S, de Waha-Thiele S, Eitel I, Neumann FJ, Hennersdorf M, Felix SB, Fach A, Böhm M, Pöss J, Jung C, Ouarrak T, Schneider S, Werdan K, Zeymer U, Thiele H. Arterial Lactate in Cardiogenic Shock: Prognostic Value of Clearance Versus Single Values. JACC Cardiovasc Interv 2021; 13:2208-2216. [PMID: 33032708 DOI: 10.1016/j.jcin.2020.06.037] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study sought to compare single lactate values at admission (L1) and after 8 h (L2) with lactate clearance (LC) for mortality prediction in cardiogenic shock (CS). BACKGROUND Early estimation of prognosis in CS complicating acute myocardial infarction is crucial for tailored treatment selection. Arterial lactate is the most widely used point-of-care parameter in CS. In septic shock, lactate reduction over time-LC-has been extensively investigated. However, in CS, only limited data exist, and the prognostic value of LC is unknown. METHODS This study is a subanalysis of the IABP-SHOCK II (Intraaortic Balloon Pump in Cardiogenic Shock II) trial and the corresponding registry. Lactate levels were prospectively collected. All-cause mortality at 30 days was assessed as primary endpoint. RESULTS For 671 of 783 (85.7%) patients, L1 and L2 values were available. The area under the receiver-operating characteristic curve (L1: 0.69; L2: 0.76; LC: 0.59) showed no difference between L1 and LC (p = 0.20). In contrast, L2 was a significantly better predictive parameter than L1 or LC (p < 0.001 for both). In multivariable stepwise Cox regression analysis, L2 ≥3.1 mmol/l (best cutoff value by Youden index) and LC <-3.45%/h remained independently predictive for time to death (p < 0.001 for both), with L2 showing the highest chi-square test score (42.1) and hazard ratio (2.89; 95% confidence interval: 2.10 to 3.97). CONCLUSIONS Arterial lactate after 8 h is superior in mortality prediction in comparison with baseline lactate and LC. A cutoff value of 3.1 mmol/l for lactate after 8 h showed the best discrimination for assessing early prognosis in CS and may serve as new treatment goal. (Intraaortic Balloon Pump in Cardiogenic Shock II [IABP-SHOCK II]; NCT00491036).
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Affiliation(s)
- Georg Fuernau
- Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.
| | - Steffen Desch
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany; Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Suzanne de Waha-Thiele
- Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Franz-Josef Neumann
- Department of Cardiology, Bad Krozingen Heart Center, University of Freiburg, Bad Krozingen, Germany
| | - Marcus Hennersdorf
- Department of Internal Medicine I, SLK Kiniken Heilbronn, Heilbronn, Germany
| | - Stephan B Felix
- Department of Internal Medicine B, University of Greifswald, Greifswald, Germany
| | - Andreas Fach
- Department of Cardiology/Angiology, Klinikum Links der Weser, Bremen, Germany
| | - Michael Böhm
- Department of Internal Medicine III, University of Homburg, Homburg/Saar, Germany
| | - Janine Pöss
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | | | | | - Karl Werdan
- Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Uwe Zeymer
- Institut für Herzinfarktforschung, Ludwigshafen, Germany; Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig and Leipzig Heart Institute, Leipzig, Germany
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Santore LA, Schurr JW, Noubani M, Rabenstein A, Dhundale K, Bilfinger TV, McLarty AJ, Seifert FC. SAVE score with lactate modification predicts in-hospital mortality in patients with ongoing cardiac arrest during VA-ECMO cannulation. Int J Artif Organs 2021; 44:787-790. [PMID: 34075820 DOI: 10.1177/03913988211021878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The survival after veno-arterial extracorporeal membrane oxygenation score and its lactate modification predict in-hospital mortality in patients based on pre-extracorporeal membrane oxygenation variables. Cardiac arrest history is a significant variable in these scores; however, patients with ongoing cardiac arrest during cannulation were excluded from these models. The goal of this study is to validate the survival after veno-arterial extracorporeal membrane oxygenation score with a lactate modification among patients with ongoing cardiac arrest. In our study, the survival after veno-arterial extracorporeal membrane oxygenation score predicted mortality in all patients, but did so with higher discrimination among ongoing cardiac arrest patients with a lactate modification.
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Affiliation(s)
- Lee Ann Santore
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - James W Schurr
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Mohammad Noubani
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Andrew Rabenstein
- Stony Brook University Hospital Department of Surgery, Stony Brook, NY, USA
| | - Kathleen Dhundale
- Stony Brook University Hospital Department of Surgery, Stony Brook, NY, USA
| | - Thomas V Bilfinger
- Stony Brook University Hospital Department of Surgery, Stony Brook, NY, USA
| | - Allison J McLarty
- Stony Brook University Hospital Department of Surgery, Stony Brook, NY, USA
| | - Frank C Seifert
- Stony Brook University Hospital Department of Surgery, Stony Brook, NY, USA
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Cytokine Adsorption in Severe Acute Respiratory Failure Requiring Veno-Venous Extracorporeal Membrane Oxygenation. ASAIO J 2021; 67:332-338. [PMID: 33627609 DOI: 10.1097/mat.0000000000001302] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is a last resort treatment option for patients with acute respiratory failure (acute respiratory distress syndrome [ARDS]). Cytokine adsorption has been incorporated in the management of some of these patients on an individual basis to control the imbalance of danger-associated molecular patterns and proinflammatory cytokines. However, little is known about the combination of V-V ECMO and cytokine adsorption as earlier reports contained mixed patient cohorts in terms of disease and mode of ECMO, veno-venous and veno-arterial. We here report single-center registry data of nine all-comers with severe ARDS treated with V-V ECMO and cytokine adsorption using the CytoSorb adsorber compared with a control group of nine propensity score matched patients undergoing V-V ECMO support without cytokine adsorption. Even though Respiratory ECMO Survival Prediction and PRedicting dEath for SEvere ARDS on V-V ECMO scores predicted a higher mortality in the cytokine adsorption group, mortality was numerically reduced in the patients undergoing V-V ECMO and cytokine removal compared with V-V ECMO alone. The need for fluid resuscitation and vasopressor support as well as lactate levels dropped significantly in the cytokine adsorption group within 72 hours, whereas vasopressor need and lactate levels did not decrease significantly in the control group. Therefore, our data suggest that cytokine adsorption might be beneficial in patients with severe ARDS requiring V-V ECMO support.
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Lamba HK, Kim M, Santiago A, Hudson S, Civitello AB, Nair AP, Loor G, Shafii AE, Liao KK, Chatterjee S. Extracorporeal membrane oxygenation as a bridge to durable left ventricular assist device implantation in INTERMACS-1 patients. J Artif Organs 2021; 25:16-23. [PMID: 33982206 DOI: 10.1007/s10047-021-01275-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/28/2021] [Indexed: 11/24/2022]
Abstract
Left ventricular assist devices (LVADs) are increasingly used as destination therapy or as a bridge to future cardiac transplant in patients with end-stage heart failure. Extracorporeal membrane oxygenation (ECMO) can be used to bridge patients in cardiogenic shock or with decompensated heart failure to durable mechanical circulatory support. We assessed outcomes in patients in critical cardiogenic shock (Interagency Registry for Mechanically Assisted Circulatory Support [INTERMACS] profile 1) who underwent implantation of a continuous-flow (CF)-LVAD, with or without preoperative ECMO bridging. For this retrospective study, we selected INTERMACS profile 1 patients who underwent CF-LVAD implantation at our institution between Sep 1, 2004 and Nov 30, 2018. Of 768 patients identified, 133 (17.3%) were INTERMACS profile 1; 26 (19.5%) received preoperative ECMO support, and 107 (80.5%) did not. Postimplantation outcomes were compared between the ECMO and no-ECMO groups. No significant differences were found in 30-day mortality (15.4 vs. 15.9%, P = 0.95) or survival at 1 year (53.8 vs. 60.9%, P = 0.51). Three patients who received ECMO before CF-LVAD implantation subsequently underwent cardiac transplant. In the ECMO group, the lactate level 1 day after ECMO initiation was lower in survivors than nonsurvivors (2.7 ± 2.2 vs. 7.4 ± 4.2 mmol/L, P = 0.02; area under the curve = 0.85, P = 0.01) after CF-LVAD implantation. Bridging with ECMO to CF-LVAD implantation in carefully selected INTERMACS profile 1 patients (those who are at the highest risk for critical cardiogenic shock and for whom palliation may be the only other option) produced acceptable postoperative outcomes.Field of research: Artificial lung/ECMO.
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Affiliation(s)
- Harveen K Lamba
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Mary Kim
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Adriana Santiago
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Samuel Hudson
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Andrew B Civitello
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA.,Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, TX, 77030, USA
| | - Ajith P Nair
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Gabriel Loor
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA.,Division of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, 77030, USA
| | - Alexis E Shafii
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA.,Division of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, 77030, USA
| | - Kenneth K Liao
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA.,Division of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, 77030, USA
| | - Subhasis Chatterjee
- Division of General Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA. .,Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA. .,Division of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, 77030, USA.
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Bemtgen X, Rilinger J, Jäckel M, Zotzmann V, Supady A, Benk C, Bode C, Wengenmayer T, Lother A, Staudacher DL. Admission blood glucose level and outcome in patients requiring venoarterial extracorporeal membrane oxygenation. Clin Res Cardiol 2021; 110:1484-1492. [PMID: 33944987 PMCID: PMC8405505 DOI: 10.1007/s00392-021-01862-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/19/2021] [Indexed: 11/26/2022]
Abstract
Background Patients with cardiogenic shock or cardiac arrest undergoing venoarterial extracorporeal membrane oxygenation (V-A ECMO) frequently present with blood glucose levels out of normal range. The clinical relevance of such findings in the context of V-A ECMO is unknown. We therefore investigated the prognostic relevance of blood glucose at time of cannulation for V-A ECMO. Methods We conducted a single-center retrospective registry study. All patients receiving V-A ECMO from October 2010 to January 2020 were included if blood glucose level at time of cannulation were documented. Patients were divided in five groups according to the initial blood glucose level ranging from hypoglycemic (< 80 mg/dl), normoglycemic (80–140 mg/dl), to mild (141-240 mg/dl), moderate (241–400 mg/dl), and severe (> 400 mg/dl) hyperglycemia, respectively. Clinical presentation, arterial blood gas analysis, and survival were compared between the groups. Results 392 patients met inclusion criteria. Median age was 62 years (51.5–70.0), SAPS II at admission was 54 (43.5–63.0), and 108/392 (27.6%) were female. 131/392 were discharged alive (hospital survival 33.4%). At time of cannulation, survivors had higher pH, hemoglobin, calcium, bicarbonate but lower potassium and lactate levels compared to non-survivors (all p < 0.01). Outcome of patients diagnosed with particularly high (> 400 mg/dl) and low (< 80 mg/dl) blood glucose at time of V-A ECMO cannulation, respectively, was worse compared to patients with normoglycemic, mildly or moderately elevated values (p = 0.02). Glucose was independently associated with poor outcome after adjustment for other predictors of survival and persisted in all investigated subgroups. Conclusion Arterial blood glucose at time of V-A ECMO cannulation predicts in-hospital survival of patients with cardiac shock or after ECPR. Whether dysglycemia represents a potential therapeutic target requires further evaluation in prospective studies. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01862-7.
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Affiliation(s)
- Xavier Bemtgen
- Department of Cardiology and Angiology I (Heart Center Freiburg-Bad Krozingen), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany.
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany.
| | - Jonathan Rilinger
- Department of Cardiology and Angiology I (Heart Center Freiburg-Bad Krozingen), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Markus Jäckel
- Department of Cardiology and Angiology I (Heart Center Freiburg-Bad Krozingen), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Viviane Zotzmann
- Department of Cardiology and Angiology I (Heart Center Freiburg-Bad Krozingen), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Alexander Supady
- Department of Cardiology and Angiology I (Heart Center Freiburg-Bad Krozingen), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Christoph Benk
- Department of Cardiovascular Surgery (University Heart Center Freiburg-Bad Krozingen), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I (Heart Center Freiburg-Bad Krozingen), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Tobias Wengenmayer
- Department of Cardiology and Angiology I (Heart Center Freiburg-Bad Krozingen), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Achim Lother
- Department of Cardiology and Angiology I (Heart Center Freiburg-Bad Krozingen), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Dawid L Staudacher
- Department of Cardiology and Angiology I (Heart Center Freiburg-Bad Krozingen), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
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Merkle-Storms J, Djordjevic I, Weber C, Avgeridou S, Krasivskyi I, Gaisendrees C, Mader N, Kuhn-Régnier F, Kröner A, Bennink G, Sabashnikov A, Trieschmann U, Wahlers T, Menzel C. Impact of Lactate Clearance on Early Outcomes in Pediatric ECMO Patients. ACTA ACUST UNITED AC 2021; 57:medicina57030284. [PMID: 33803807 PMCID: PMC8003148 DOI: 10.3390/medicina57030284] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/07/2021] [Accepted: 03/15/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Pediatric extracorporeal membrane oxygenation (ECMO) support is often the ultimate therapy for neonatal and pediatric patients with congenital heart defects after cardiac surgery. The impact of lactate clearance in pediatric patients during ECMO therapy on outcomes has been analyzed. Materials andMethods: We retrospectively analyzed data from 41 pediatric vaECMO patients between January 2006 and December 2016. Blood lactate and lactate clearance have been recorded prior to ECMO implantation and 3, 6, 9 and 12 h after ECMO start. Receiver operating characteristic (ROC) analysis was used to identify cut-off levels for lactate clearance. Results: Lactate levels prior to ECMO therapy (9.8 mmol/L vs. 13.5 mmol/L; p = 0.07) and peak lactate levels during ECMO support (10.4 mmol/L vs. 14.7 mmol/L; p = 0.07) were similar between survivors and nonsurvivors. Areas under the curve (AUC) of lactate clearance at 3, 9 h and 12 h after ECMO start were significantly predictive for mortality (p = 0.017, p = 0.049 and p = 0.006, respectively). Cut-off values of lactate clearance were 3.8%, 51% and 56%. Duration of ECMO support and respiratory ventilation was significantly longer in survivors than in nonsurvivors (p = 0.01 and p < 0.001, respectively). Conclusions: Dynamic recording of lactate clearance after ECMO start is a valuable tool to assess outcomes and effectiveness of ECMO application. Poor lactate clearance during ECMO therapy in pediatric patients is a significant marker for higher mortality.
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Affiliation(s)
- Julia Merkle-Storms
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
- Correspondence: (J.M.-S.); (I.D.)
| | - Ilija Djordjevic
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
- Correspondence: (J.M.-S.); (I.D.)
| | - Carolyn Weber
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
| | - Soi Avgeridou
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
| | - Ihor Krasivskyi
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
| | - Christopher Gaisendrees
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
| | - Navid Mader
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
| | - Ferdinand Kuhn-Régnier
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
| | - Axel Kröner
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
| | - Gerardus Bennink
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
| | - Anton Sabashnikov
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
| | - Uwe Trieschmann
- Anaesthesiology and Intensive Care Medicine, University of Cologne, 50924 Cologne, Germany; (U.T.); (C.M.)
| | - Thorsten Wahlers
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
| | - Christoph Menzel
- Anaesthesiology and Intensive Care Medicine, University of Cologne, 50924 Cologne, Germany; (U.T.); (C.M.)
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Abdullah KQA, Roedler JV, vom Dahl J, Szendey I, Haake H, Eckardt L, Topf A, Ohnewein B, Jirak P, Motloch LJ, Wernly B, Larbig R. Impella use in real-world cardiogenic shock patients: Sobering outcomes. PLoS One 2021; 16:e0247667. [PMID: 33635889 PMCID: PMC7909706 DOI: 10.1371/journal.pone.0247667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/10/2021] [Indexed: 11/21/2022] Open
Abstract
Background Critically ill patients with cardiogenic shock could benefit from ventricular assist device support using the Impella microaxial blood pump. However, recent studies suggested Impella not to improve outcomes. We, therefore, evaluated outcomes and predictors in a real-world scenario. Methods In this retrospective single-center trial, 125 patients suffering from cardiac arrest/cardiogenic shock between 2008 and 2018 were analyzed. 93 Patients had a prior successful cardiopulmonary resuscitation. The primary endpoint was hospital mortality. Associations of covariates with the primary endpoint were assessed by univariable and multivariable logistic regression. Adjusted odds ratios (aOR) and optimal cut-offs (using Youden index) were obtained. Results Hospital mortality was high (81%). Baseline lactate was 4.7mmol/L [IQR = 7.1mmol/L]. In multivariable logistic regression, only age (aOR 1.13 95%CI 1.06–1.20; p<0.001) and lactate (aOR 1.23 95%CI 1.004–1.516; p = 0.046) were associated with hospital mortality, and the respective optimal cut-offs were >3.3mmol/L and age >66 years. Patients were retrospectively stratified into three risk groups: Patients aged ≤66 years and lactate ≤3.3mmol (low-risk; n = 22); patients aged >66 years or lactate >3.3mmol/L (medium-risk; n = 52); and patients both aged >66 years and lactate >3.3mmol/L (high-risk, n = 51). Risk of death increased from 41% in the low-risk group, to 79% in the medium risk group and 100% in the high-risk group. The predictive abilities of this model were high (AUC 0.84; 95% 0.77–0.92). Conclusion Mortality was high in this real-world collective of severely ill cardiogenic shock patients. Better patient selection is warranted to avoid unethical use of Impella. Age and lactate might help to improve patient selection.
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Affiliation(s)
- Khaled Q. A. Abdullah
- Division of Cardiology, Hospital Maria Hilf Mönchengladbach, Mönchengladbach, Germany
- Department of Cardiology, RWTH Aachen University, Aachen, Germany
| | - Jana V. Roedler
- Division of Cardiology, Hospital Maria Hilf Mönchengladbach, Mönchengladbach, Germany
| | - Juergen vom Dahl
- Division of Cardiology, Hospital Maria Hilf Mönchengladbach, Mönchengladbach, Germany
| | - Istvan Szendey
- Division of Cardiology, Hospital Maria Hilf Mönchengladbach, Mönchengladbach, Germany
| | - Hendrik Haake
- Division of Cardiology, Hospital Maria Hilf Mönchengladbach, Mönchengladbach, Germany
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | - Albert Topf
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Ohnewein
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Peter Jirak
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Lukas J. Motloch
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Wernly
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
- Center for Public Health and Healthcare Research, Paracelsus Medical University, Salzburg, Austria
| | - Robert Larbig
- Division of Cardiology, Hospital Maria Hilf Mönchengladbach, Mönchengladbach, Germany
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
- * E-mail:
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41
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Serum Lactate and A Relative Change in Lactate as Predictors of Mortality in Patients With Cardiogenic Shock - Results from the Cardshock Study. Shock 2021; 53:43-49. [PMID: 30973460 DOI: 10.1097/shk.0000000000001353] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Cardiogenic shock complicating acute myocardial infarction has a very high mortality. Our present study focuses on serial measurement of lactate during admission due to cardiogenic shock and the prognostic effect of lactate and a relative change in lactate in patients after admission and the institution of intensive care treatment. METHODS AND RESULTS This is a secondary analysis of the CardShock study. Data on lactate at baseline were available on 217 of 219 patients.In the study population, the median baseline lactate was 2.8 mmol/L (min-max range, 0.5-23.1 mmol/L).At admission, lactate was predictive of 30-day mortality with an adjusted Hazard ratio (HR) of 1.20 mmol/L (95% confidence interval, CI 1.14-1.27). Within the first 24 h of admission, baseline lactate remained predictive of 30-day mortality. Lactate at 6 h had a HR of 1.14 (95% CI 1.06-1.24) and corresponding values at 12 and 24 h had a HR of 1.10 (1.04-1.17), and of HR 1.19 (95% CI 1.07-1.32), respectively. A 50% reduction in lactate within 6 h resulted in a HR of 0.82 (95% CI 0.72-0.94). Corresponding hazard ratios at 12 and 24 h, were 0.87 (95% CI 0.76-0.98) and 0.74 (95% CI 0.60-0.91), respectively. CONCLUSION The main findings of the present study are that baseline lactate is a powerful predictor of 30-day mortality, lactate at 6, 12, and 24 h after admission are predictors of 30-day mortality, and a relative change in lactate is a significant predictor of survival within the first 24 h after instituting intensive care treatment adding information beyond the information from baseline values.
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Kim AR, Park H, Lee SE, Ahn JM, Park DW, Lee SW, Kim JJ, Park SJ, Hong JA, Kang PJ, Jung SH, Kim MS. Outcomes of left ventricular unloading with a transseptal cannula during extracorporeal membrane oxygenation in adults. Artif Organs 2020; 45:390-398. [PMID: 33001468 DOI: 10.1111/aor.13838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/16/2020] [Accepted: 09/24/2020] [Indexed: 12/20/2022]
Abstract
We evaluated the benefit of left ventricular (LV) unloading using a percutaneous transseptal left atrial (LA) drain catheter via femoral vein incorporated into the ECMO venous circuit. This single-center retrospective observational study analyzed clinical outcomes of the LA venting group (N = 62) who underwent percutaneous transseptal LA drain placement comparing with the conventionally treated control group (N = 62) with an arterial pulse pressure below 10 mm Hg for at least 24 hours from December 2012 to August 2018. The ECMO weaning rate (61.3% vs. 38.7%, P = .012) and cardiac transplantation rate (29.0% vs. 11.3%, P = .014) were higher in the LA venting group than in the control group. Inhospital mortality was not significantly different (56.5% vs. 69.4%, P = .191). Pulmonary congestion mostly improved after LA decompression (61.3%, P = .003). A serum lactate level at 24 hours after LA venting of more than 2.2 mmol/L was associated with poor outcomes. LA venting via transseptal cannula reduced pulmonary venous congestion and achieved higher rates of successful ECMO weaning and cardiac transplantation. Placement of a transseptal venous drain cannula should be considered in patients with uncontrolled pulmonary edema secondary to severe LV loading undergoing VA-ECMO.
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Affiliation(s)
- Ah-Ram Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanbit Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Eun Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Min Ahn
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Woo Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Whan Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Joong Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Ae Hong
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Pil-Je Kang
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Seok Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Scolari FL, Schneider D, Fogazzi DV, Gus M, Rover MM, Bonatto MG, de Araújo GN, Zimerman A, Sganzerla D, Goldraich LA, Teixeira C, Friedman G, Polanczyk CA, Rohde LE, Rosa RG, Wainstein RV. Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study. BMC Cardiovasc Disord 2020; 20:496. [PMID: 33234107 PMCID: PMC7687839 DOI: 10.1186/s12872-020-01785-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/12/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND To evaluate the prognostic value of peak serum lactate and lactate clearance at several time points in cardiogenic shock treated with temporary mechanical circulatory support (MCS) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) or Impella CP®. METHODS Serum lactate and clearance were measured before MCS and at 1 h, 6 h, 12 h, and 24 h post-MCS in 43 patients at four tertiary-care centers in Southern Brazil. Prognostic value was assessed by univariable and multivariable analysis and receiver operating characteristic (ROC) curves for 30-day mortality. RESULTS VA-ECMO was the most common MCS modality (58%). Serum lactate levels at all time points and lactate clearance after 6 h were associated with mortality on unadjusted and adjusted analyses. Lactate levels were higher in non-survivors at 6 h, 12 h, and 24 h after MCS. Serum lactate > 1.55 mmol/L at 24 h was the best single prognostic marker of 30-day mortality [area under the ROC curve = 0.81 (0.67-0.94); positive predictive value = 86%). Failure to improve serum lactate after 24 h was associated with 100% mortality. CONCLUSIONS Serum lactate was an important prognostic biomarker in cardiogenic shock treated with temporary MCS. Serum lactate and lactate clearance at 24 h were the strongest independent predictors of short-term survival.
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Affiliation(s)
- Fernando Luís Scolari
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos 630, 10º andar, Porto Alegre, RS 90035-001 Brazil
- Division of Cardiology, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 630, Porto Alegre, RS 90035-001 Brazil
| | - Daniel Schneider
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos 630, 10º andar, Porto Alegre, RS 90035-001 Brazil
| | - Débora Vacaro Fogazzi
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos 630, 10º andar, Porto Alegre, RS 90035-001 Brazil
| | - Miguel Gus
- Division of Cardiology, HMV, Rua Tiradentes, 333, Porto Alegre, RS 90560-030 Brazil
| | - Marciane Maria Rover
- Division of Cardiology, HMV, Rua Tiradentes, 333, Porto Alegre, RS 90560-030 Brazil
- Heart Failure and Transplant Division, Instituto de Cardiologia – Fundação Universitária de Cardiologia, Av. Princesa Isabel, 395, Porto Alegre, RS 90040-371 Brazil
| | - Marcely Gimenes Bonatto
- Cardiology Department, Transplant Division, Irmandade Hospital da Santa Casa de Misericórdia de Curitiba, Praça Rui Barbosa, 694, Curitiba, PR 80010-030 Brazil
| | - Gustavo Neves de Araújo
- Division of Cardiology, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 630, Porto Alegre, RS 90035-001 Brazil
- Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences,, UFGRS, Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-007 Brazil
| | - André Zimerman
- Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences,, UFGRS, Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-007 Brazil
| | - Daniel Sganzerla
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos 630, 10º andar, Porto Alegre, RS 90035-001 Brazil
| | - Lívia Adams Goldraich
- Division of Cardiology, London Health Sciences Center and Western University, London, Canada
- Heart Transplant and Mechanical Circulatory Support Program, Division of Cardiology, HCPA, Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-007 Brazil
| | - Cassiano Teixeira
- Division of Critical Care Medicine, HMV, R. Tiradentes, 333, Porto Alegre, 90560-030 Brazil
| | - Gilberto Friedman
- Division of Critical Care Medicine, HCPA, Rua Ramiro Barcelos 630, Porto Alegre, 90035-001 Brazil
- Universidade Federal do Rio Grande do Sul, R. Tiradentes, 333, Porto Alegre, 90560-030 Brazil
| | - Carisi Anne Polanczyk
- Division of Cardiology, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 630, Porto Alegre, RS 90035-001 Brazil
- Division of Cardiology, HMV, Rua Tiradentes, 333, Porto Alegre, RS 90560-030 Brazil
- Universidade Federal do Rio Grande do Sul, R. Tiradentes, 333, Porto Alegre, 90560-030 Brazil
| | - Luis Eduardo Rohde
- Division of Cardiology, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 630, Porto Alegre, RS 90035-001 Brazil
- Division of Cardiology, HMV, Rua Tiradentes, 333, Porto Alegre, RS 90560-030 Brazil
- Universidade Federal do Rio Grande do Sul, R. Tiradentes, 333, Porto Alegre, 90560-030 Brazil
| | - Regis Goulart Rosa
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos 630, 10º andar, Porto Alegre, RS 90035-001 Brazil
| | - Rodrigo Vugman Wainstein
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos 630, 10º andar, Porto Alegre, RS 90035-001 Brazil
- Division of Cardiology, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 630, Porto Alegre, RS 90035-001 Brazil
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Mariscalco G, Salsano A, Fiore A, Dalén M, Ruggieri VG, Saeed D, Jónsson K, Gatti G, Zipfel S, Dell'Aquila AM, Perrotti A, Loforte A, Livi U, Pol M, Spadaccio C, Pettinari M, Ragnarsson S, Alkhamees K, El-Dean Z, Bounader K, Biancari F, Dashey S, Yusuff H, Porter R, Sampson C, Harvey C, Settembre N, Fux T, Amr G, Lichtenberg A, Jeppsson A, Gabrielli M, Reichart D, Welp H, Chocron S, Fiorentino M, Lechiancole A, Netuka I, De Keyzer D, Strauven M, Pälve K. Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: Multicenter registry, systematic review, and meta-analysis. J Thorac Cardiovasc Surg 2020; 160:1207-1216.e44. [DOI: 10.1016/j.jtcvs.2019.10.078] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/04/2019] [Accepted: 10/04/2019] [Indexed: 12/13/2022]
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Nersesian G, Tschöpe C, Spillmann F, Gromann T, Roehrich L, Mueller M, Mulzer J, Starck C, Falk V, Schoenrath F, Potapov E. Prediction of survival of patients in cardiogenic shock treated by surgically implanted Impella 5+ short-term left ventricular assist device. Interact Cardiovasc Thorac Surg 2020; 31:475-482. [DOI: 10.1093/icvts/ivaa150] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/28/2020] [Accepted: 07/01/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
Short-term mechanical circulatory support is a life-saving treatment for acute cardiogenic shock (CS). This multicentre study investigates the preoperative predictors of 30-day mortality in CS patients treated with Impella 5.0 and 5.5 short-term left ventricular assist devices.
METHODS
Data of patients in CS (n = 70) treated with the Impella 5 (n = 63) and 5.5 (n = 7) in 2 centres in Berlin between October 2016 and October 2019 were collected retrospectively.
RESULTS
CS was caused by acute myocardial infarction (n = 16), decompensated chronic heart failure (n = 41), postcardiotomy syndrome (n = 5) and acute myocarditis (n = 8). Before implantation 12 (17%) patients underwent cardiopulmonary resuscitation and 32 (46%) patients were ventilated. INTERMACS level 1, 2 and 3 was established in 35 (50%), 29 (41%) and 6 (9%) of patients, respectively. The mean preoperative lactate level was 4.05 mmol/l. The median support time was 7 days (IR= 4–15). In 18 cases, the pump was removed for myocardial recovery, in 22 cases, durable left ventricular assist devices were implanted, and 30 patients died on support. The overall 30-day survival was 51%. Statistical analysis showed that an increase in lactate per mmol/l [odds ratio (OR) 1.217; P = 0.015] and cardiopulmonary resuscitation before implantation (OR 16.74; P = 0.009) are predictors of 30-day survival. Based on these data, an algorithm for optimal short-term mechanical circulatory support selection is proposed.
CONCLUSIONS
Impella treatment is feasible in severe CS. Severe organ dysfunction, as well as the level and duration of shock predict early mortality. An algorithm based on these parameters may help identify patients who would benefit from Impella 5+ support.
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Affiliation(s)
- Gaik Nersesian
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Carsten Tschöpe
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapy (BCRT), Charité, University Medicine Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Frank Spillmann
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tom Gromann
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Luise Roehrich
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- German Heart Foundation, Frankfurt am Main, Germany
| | - Marcus Mueller
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Johanna Mulzer
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
- Institute of Health (BIH), Berlin, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Evgenij Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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Siao FY, Chiu CW, Chiu CC, Chang YJ, Chen YC, Chen YL, Hsieh YK, Chou CC, Yen HH. Can we predict patient outcome before extracorporeal membrane oxygenation for refractory cardiac arrest? Scand J Trauma Resusc Emerg Med 2020; 28:58. [PMID: 32576294 PMCID: PMC7310513 DOI: 10.1186/s13049-020-00753-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 06/08/2020] [Indexed: 11/10/2022] Open
Abstract
Background Refractory cardiac arrest resistant to conventional cardiopulmonary resuscitation (C-CPR) has a poor outcome. Although previous reports showed that extracorporeal cardiopulmonary resuscitation (E-CPR) can improve the clinical outcome, there are no clinically applicable predictors of patient outcome that can be used prior to the implementation of E-CPR. We aimed to evaluate the use of clinical factors in patients with refractory cardiac arrest undergoing E-CPR to predict patient outcome in our institution. Methods This is a single-center retrospective study. We report 112 patients presenting with refractory cardiac arrest resistant to C-CPR between January 2012 and November 2017. All patients received E-CPR for continued life support when a cardiogenic etiology was presumed. Clinical factors associated with patient outcome were analyzed. Significant pre-ECMO clinical factors were extracted to build a patient outcome risk prediction model. Results The overall survival rate at discharge was 40.2, and 30.4% of patients were discharged with good neurologic function. The six-month survival rate after hospital discharge was 36.6, and 25.9% of patients had good neurologic function 6 months after discharge. We stratified the patients into low-risk (n = 38), medium-risk (n = 47), and high-risk groups (n = 27) according to the TLR score (low-flow Time, cardiac arrest Location, and initial cardiac arrest Rhythm) that we derived from pre-ECMO clinical parameters. Compared with the medium-risk and high-risk groups, the low-risk group had better survival at discharge (65.8% vs. 42.6% vs. 0%, p < 0.0001) and at 6 months (60.5% vs. 38.3% vs. 0%, p = 0.0001). The low-risk group also had a better neurologic outcome at discharge (50% vs. 31.9% vs. 0%, p = 0.0001) and 6 months after discharge (44.7% vs. 25.5% vs. 0%, p = 0.0003) than the medium-risk and high-risk groups. Conclusions Patients with refractory cardiac arrest receiving E-CPR can be stratified by pre-ECMO clinical factors to predict the clinical outcome. Larger-scale studies are required to validate our observations.
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Affiliation(s)
- Fu-Yuan Siao
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan.,Department of Critical Care Medicine, Changhua Christian Hospital, Changhua, Taiwan.,Department of Mechanical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Chun-Wen Chiu
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Chun-Chieh Chiu
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Yu-Jun Chang
- Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Ying-Chen Chen
- Department of Cardiovascular Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Yao-Li Chen
- Department of Cardiovascular Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Yung-Kun Hsieh
- Department of Cardiovascular Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Chu-Chung Chou
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsu-Hen Yen
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan. .,College of Medicine, Chung-Shan Medical University, Taichung, Taiwan.
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Su Y, Liu K, Zheng JL, Li X, Zhu DM, Zhang Y, Zhang YJ, Wang CS, SHI TT, Luo Z, Tu GW. Hemodynamic monitoring in patients with venoarterial extracorporeal membrane oxygenation. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:792. [PMID: 32647717 PMCID: PMC7333156 DOI: 10.21037/atm.2020.03.186] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an effective mechanical circulatory support modality that rapidly restores systemic perfusion for circulatory failure in patients. Given the huge increase in VA-ECMO use, its optimal management depends on continuous and discrete hemodynamic monitoring. This article provides an overview of VA-ECMO pathophysiology, and the current state of the art in hemodynamic monitoring in patients with VA-ECMO.
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Affiliation(s)
- Ying Su
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Kai Liu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ji-Li Zheng
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xin Li
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Du-Ming Zhu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ying Zhang
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yi-Jie Zhang
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Chun-Sheng Wang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Tian-Tian SHI
- Department of medicine, Yale New Haven Health/Bridgeport Hospital, Bridgeport, USA
| | - Zhe Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Department of Critical Care Medicine, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen 361015, China
| | - Guo-Wei Tu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Abstract
Management of pulmonary embolism (PE) has become more complex due to the expanded role of catheter-based therapies, surgical thrombectomies, and cardiac assist technologies, such as right ventricular assist devices and extracorporeal support. Due to the heterogeneity of PE, a multidisciplinary team approach is necessary. The manifestation of PE response teams are in response to this complex need and similar to the proliferation of stroke, trauma, and rapid response teams. Intensive care units are an ideal location for formulating a comprehensive treatment plan that necessitates an interaction between multiple specialties. This article addresses the unique needs of critically ill patients with PE.
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Affiliation(s)
- Michael Baram
- Department of Medicine, Division of Pulmonary and Critical Care, Jefferson University Hospital, Korman Lung Institute, 834 Walnut Street, Suite 650, Philadelphia, PA 19107, USA.
| | - Bharat Awsare
- Department of Medicine, Division of Pulmonary and Critical Care, Jefferson University Hospital, Korman Lung Institute, 834 Walnut Street, Suite 650, Philadelphia, PA 19107, USA
| | - Geno Merli
- Department of Medicine and Surgery, Division of Vascular Medicine, Jefferson University Hospital, 111 South 11th Street Suite 6210, Philadelphia, PA 19107, USA
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Abstract
PURPOSE OF REVIEW Cardiogenic shock remains beside sudden cardiac death the most outcome relevant complication of acute myocardial infarction. Over the last two decades as confirmation of the benefit of early revascularization no further relevant improvement in outcome could be achieved. Biomarkers are important for diagnosis, monitoring, and management in cardiogenic shock patients. RECENT FINDINGS A bunch of different biomarkers have been associated with prognosis in patients with cardiogenic shock. In routine use standard parameters such as serum lactate or serum creatinine are still most important in monitoring these patients. These established markers outperformed novel markers in prognostic impact in recent trials. SUMMARY Biomarkers serve as important treatment targets and may help physicians in therapeutic decision-making. Furthermore, the complex pathophysiology of cardiogenic shock may be better understood by investigation of different biomarkers.
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Hu RTC, Broad JD, Osawa EA, Ancona P, Iguchi Y, Miles LF, Bellomo R. 30-Day Outcomes Post Veno-Arterial Extra Corporeal Membrane Oxygenation (VA-ECMO) After Cardiac Surgery and Predictors of Survival. Heart Lung Circ 2020; 29:1217-1225. [PMID: 32171614 DOI: 10.1016/j.hlc.2020.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/09/2020] [Accepted: 01/20/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is sometimes needed for post-cardiotomy cardiogenic shock (PCCS). There is little data regarding outcomes in the Australian context, particularly in a non-cardiac transplant centre. Our aim was to report on 30-day outcomes after patients with PCCS treated with VA-ECMO in an Australian non-cardiac transplant tertiary centre, and to determine risk factors for non-survival in this population. METHODS A retrospective analysis was performed on all adults treated with VA-ECMO for PCCS between August 2001 and September 2016 at our centre. Univariate analysis with adjustment for multiplicity identified risk factors for non-survival. Area under the receiver operating characteristics (AUROC) method was used to assess their predictive value. RESULTS We identified 64 patients out of 5,502 open-heart surgery cases of which three patients did not meet inclusion criteria. Mean (SD) age was 63 (14) years. Survival to hospital discharge or 30 days post VA-ECMO occurred in 27/61 (44%) patients. VA-ECMO was able to be weaned in 44/61 patients (72%); 54/61 patients (89%) had at least one major complication. Prior to VA-ECMO initiation, no statistically significant differences between survivors and non-survivors could be determined. After VA-ECMO initiation, only 24-hour nadir lactate and 48-hour nadir lactate levels were significantly different between survivors and non-survivors (1.50 mmol/L vs 3.20 mmol/L p=0.001; and 1.20 mmol/L vs. 1.90 mmol/L p=0.001 respectively). For mortality prediction, 24- and 48-hour nadir lactate levels had AUROCs of 0.775 and 0.782, respectively. CONCLUSIONS VA-ECMO is associated with acceptable survival rates but significant morbidity. Nadir lactate levels in the first 24 and 48 hours after VA-ECMO initiation may be useful in predicting early survival.
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Affiliation(s)
- Raymond T C Hu
- Department of Anaesthesia, Austin Health, Melbourne, Vic, Australia.
| | - Jeremy D Broad
- Department of Anaesthesia, Austin Health, Melbourne, Vic, Australia
| | - Eduardo A Osawa
- Department of Intensive Care, Austin Health, Melbourne, Vic, Australia
| | - Paolo Ancona
- Department of Intensive Care, Austin Health, Melbourne, Vic, Australia
| | - Yoko Iguchi
- Department of Intensive Care, Austin Health, Melbourne, Vic, Australia
| | - Lachlan F Miles
- Department of Anaesthesia, Austin Health, Melbourne, Vic, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Health, Melbourne, Vic, Australia
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