title: The peak of blood lactate during the first 24h predicts mortality in acute coronary syndrome patients under extracorporeal membrane oxygenation.
abstract: BACKGROUND
  Parameters allowing for outcome discrimination of extracorporeal membrane oxygenation (ECMO) therapy in acute coronary syndromes (ACS) complicated by refractory cardiogenic shock (CS) and/or cardio-respiratory arrest (CA) remain elusive. We aimed at evaluating the potential prognostic roles of blood and procedural parameters associated with 30-day mortality following ECMO.
  
  
  RESULTS
  A group of 29 patients with ACS complicated by CS and/or CA, who underwent ECMO at a single center, was retrospectively analyzed. Eighteen patients (62%) died at 30-day follow up. "Survivors" and "non-survivors" had similar demographics, clinical and biochemical characteristics at admission, except for blood lactate peak in the first 24h that was increased in non-survivors. Procedural characteristics of percutaneous coronary intervention (PCI) and ECMO were comparable in either group. The peak of blood lactate concentration predicted 30-day mortality independently of age, sex and ECMO duration. The cutoff value, determined by receiver operating characteristic (ROC) curve analysis, was found at 11mmol/l.
  
  
  CONCLUSIONS
  The peak of serum lactate under ECMO in the first 24h predicted 30-day mortality in patients with ACS complicated with CS and CA.
authors.affiliation: Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland. Electronic address: Fabio.rigamonti@hcuge.ch.
authors.forename: Fabio
authors.initials: F
authors.lastname: Rigamonti
authors.affiliation: Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS AOU San Martino-IST Genova, 10 Largo Rosanna Benzi, 16132 Genoa, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Montecucco
authors.affiliation: Intensive Care Unit, Departement of Anesthesiology and Intensive Care Specialities, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland.
authors.forename: Filippo
authors.initials: F
authors.lastname: Boroli
authors.affiliation: Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland.
authors.forename: Florian
authors.initials: F
authors.lastname: Rey
authors.affiliation: Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland.
authors.forename: Baris
authors.initials: B
authors.lastname: Gencer
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Cikirikcioglu
authors.affiliation: Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Reverdin
authors.affiliation: Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Carbone
authors.affiliation: Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland.
authors.forename: Stephane
authors.initials: S
authors.lastname: Noble
authors.affiliation: Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Roffi
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland.
authors.forename: Carlo
authors.initials: C
authors.lastname: Banfi
authors.affiliation: Intensive Care Unit, Departement of Anesthesiology and Intensive Care Specialities, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland.
authors.forename: Raphael
authors.initials: R
authors.lastname: Giraud
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D019344:Lactic Acid
keywords: Acute coronary syndrome; Cardiogenic shock; Extracorporeal cardiopulmonary resuscitation; Extracorporeal membrane oxygenation