Does lactate clearance prognosticates outcomes in ECMO therapy: a retrospective observational study

Area of Science:

• Cardiology
• Critical Care Medicine
• Biochemistry

Background:

• Extracorporeal Membrane Oxygenation (ECMO) is a vital, though high-mortality, treatment for refractory cardiogenic shock.
• Assessing lactate level dynamics during ECMO is important for patient outcomes.

Purpose of the Study:

• To evaluate the prognostic role of lactate level fluctuations and clearance during ECMO therapy.
• To determine if lactate clearance metrics can predict 30-day mortality in ECMO patients.

Main Methods:

• Retrospective analysis of 48 patients receiving ECMO for cardiogenic shock (January 2015-December 2017).
• Lactate levels were recorded pre-ECMO and at set intervals.
• Lactate clearance at specific time points (LC-1) and duration of >10% lactate reduction (LC-2) were calculated.
• ROC curves and Mann Whitney U-test were used to analyze 30-day mortality prediction.

Main Results:

• ECMO therapy for cardiogenic shock had a 70.8% mortality rate.
• Lactate levels and their dynamic changes significantly correlated with mortality.
• LC-2 demonstrated strong discrimination for 30-day mortality (AUC=0.97).
• Other lactate-related metrics (LAE-LBE, L48-LBE) showed moderate predictive power.

Conclusions:

• Lactate level changes post-ECMO implantation are superior to single measurements for predicting mortality.
• Early ECMO initiation before lactate levels rise is suggested.
• Serial lactate measurements and clearance calculations offer better prognostic prediction than single lactate values.