Serial Lactate Measurements as a Prognostic Tool in Venovenous Extracorporeal Membrane Oxygenation Support.
BACKGROUND
Serial lactate measurements over time or lactate clearance has been reported to be clinically reliable for risk stratification in different pathologic conditions ranging from sepsis to trauma, but no data are so far available on the behavior of lactate during venovenous extracorporeal membrane oxygenation (VV-ECMO) support in refractory adult acute respiratory distress syndrome (ARDS).


METHODS
We assessed lactate values during VV-ECMO support and the prognostic role of lactate clearance at 6, 24, and 72 hours after ECMO start in 126 consecutive patients with refractory ARDS treated with VV-ECMO.


RESULTS
Survivors showed a progressive, significant decrease in lactate values throughout the study period, whereas nonsurvivors exhibited a progressive increase. Lactate values (measured before ECMO initiation, as well as 6 and 24 hours after) were independently associated with intensive care unit (ICU) death. A significantly higher lactate clearance was observed for survivors at 72 hours after ECMO start than for nonsurvivors. At logistic regression analysis, lactate clearance at 72 hours after ECMO start was an independent predictor of ICU death (odds ratio 0.988, 95% confidence interval [CI]: 0.995 to 0.982, p = 0.001) (together with age, body mass index, and Sequential Organ Failure Assessment). At receiver operating characteristic curve analysis, lactate clearance at 72 hours after ECMO start cutoff value of -16% had a sensitivity of 68% and a specificity of 63% (area under the curve = 0.67, 95% CI: 0.57 to 0.77, p = 0.002).


CONCLUSIONS
Lactate (measured before ECMO initiation, as well as 6 and 24 hours after) is a prognostic factor in patients with refractory ARDS treated with VV-ECMO, and lactate clearance at 72 hours after ECMO initiation helps in the risk stratification of these patients, being independently associated with death.
Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Manuela
M
Bonizzoli
Intensive Care Unit of Cardiovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. Electronic address: lazzeric@libero.it.
Chiara
C
Lazzeri
Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Giovanni
G
Cianchi
Intensive Care Unit of Cardiovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Maria
M
Boddi
Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Morena
M
Cozzolino
Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Simona
S
Di Valvasone
Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Paolo
P
Terenzi
Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Stefano
S
Batacchi
Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Marco
M
Chiostri
Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Adriano
A
Peris
D000328:Adult; D000368:Aged; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis
D019344:Lactic Acid