Early lactate is a novel prognostic indicator of prognosis in patients with extracorporeal cardiopulmonary resuscitation
10.3760/cma.j.issn.1671-0282.2022.12.006
- VernacularTitle:早期乳酸判断体外心肺复苏患者预后的研究
- Author:
Feng SUN
1
;
Huazhong ZHANG
;
Yong MEI
;
Jinru LV
;
Wei LI
;
Gang ZHANG
;
Deliang HU
;
Xufeng CHEN
Author Information
1. 南京医科大学第一附属医院急诊医学中心，南京 210029
- Keywords:
extracorporeal cardiopulmonary resuscitation;
extracorporeal membrane oxygenation;
prognosis;
lactate;
pH;
shockable rhythm;
independent risk factors;
termin
- From:
Chinese Journal of Emergency Medicine
2022;31(12):1608-1611
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the prognostic value of early lactate in patients with extracorporeal cardiopulmonary resuscitation (ECPR).Methods:A retrospective analysis was performed on the clinical data of patients with ECPR in the Emergency Medicine Department of The First Affiliated Hospital of Nanjing Medical University from March 2015 to August 2021. The age, sex, etiology, initial rhythm, prognosis, blood lactate and pH of patients with ECPR were collected, and their difference between the deceased and survived patients was compared.Results:Totally 95 patients were enrolled, with an average age of 47 years; male accounted for 69.5%, and the survival rate was 29.5%. There was no significant difference in age and sex ratio between the deceased and survived patients. However, the deceased patients had a significant lower rate of shockable rhythms (31.3% vs. 60.8%), a higher level of lactate [16.4 (11.2, 19.1) vs. 9.2 (3.2, 15.0), mmol/L], and a lower pH [7.01 (6.88, 7.23) vs. 7.37 (7.10, 7.43)] than the survived patients. Multivariate binary logistic regression analysis showed that shockable rhythm [odds ratio ( OR) = 0.295, 95% confidence interval ( CI): 0.118-0.739), lactate ( OR=1.159, 95% CI: 1.068-1.258) and pH ( OR= 0.017, 95% CI: 0.002-0.157) were independent risk factors for poor prognosis. Furthermore, a lactate level >24 mmol/L was the best threshold to predict mortality with a specificity of 100%. Combined application, the cutoff point was lactate level>16 mmol/L and pH <6.828. Conclusions:Shockable rhythm, higher early lactate and lower pH value are independent risk factors for prognosis in patients with ECPR. Early lactate > 24 mmol/L or lactate > 16 mmol/L companied with pH < 6.828 are novel indicators of the termination of ECPR.
