Prognostic value of Blood Lactate and Lactate clearance in refractory cardiac arrest treated by Extra Corporeal Life Support [Turk J Anaesthesiol Reanim]
Turk J Anaesthesiol Reanim. Ahead of Print: TARD-96992

Prognostic value of Blood Lactate and Lactate clearance in refractory cardiac arrest treated by Extra Corporeal Life Support

Romain Jouffroy, Anastasia Saade, Pascal Philippe, Pierre Carli, Benoit Vivien
Departments of Anaesthesia & Intensive Care Unit, SAMU, Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, 149 rue de Sèvres, 75015 Paris, France.

Objective: During cardiac arrest (CA) resuscitation, an “ischemia-reperfusion” syndrome occurs leading to multi-organ failure reflected by an increase in blood lactate. Blood lactate is a diagnosis and prognosis biomarker in Extra Corporeal Life Support (ECLS), but its kinetic appears more informative to assess a patient’s outcome. The aim of this study was to describe the prognosis value of blood lactate and lactate clearance (LC) 3 (H3) and 6 hours (H6) after the initiation of ECLS in the treatment of refractory CA.
Methods: Patients admitted to the intensive care unit for refractory CA were included. Lactate measurements were performed at the initiation of ECLS (H0), at H3 and H6 upon the initiation of ECLS. LC was measured from 0 to 3 hours (LC03), 0 to 6 hours (LC06), and 3 to 6 hours (LC36). The primary endpoint was in-hospital mortality within 28 days.
Results: Sixty-six patients were enrolled. Lactate levels were higher in deceased patients. Increased mortality was observed with increasing levels of lactate at H3 and H6 and, with decreasing LC03. Using logistic regression, an association was observed between mortality and lactate at H3 with an OR of 1.21 (95CI [1.05-1.42]), LC03, OR of 0.93 (95CI [0.87-0.99]), and LC06, OR of 0.96 (95CI [0.92-0.99]).
Conclusion: Blood lactate and LC within the first 3 hours of ECLS in refractory CA are associated with mortality. LC is a more relevant parameter than blood lactate taking into accounts both the production and elimination of lactate. We suggest to preferentially use LC to assess patient’s outcome.

Keywords: cardiac arrest, lactate, ECMO, intensive care, resuscitation




Corresponding Author: Romain Jouffroy, France


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