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Impact of Lactate Clearance on Early Outcomes in Pediatric ECMO Patients

Julia Merkle-Storms1, Ilija Djordjevic1, Carolyn Weber1

  • 1Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany.

Medicina (Kaunas, Lithuania)
|April 3, 2021
PubMed

Insights

Lactate clearance during pediatric extracorporeal membrane oxygenation (ECMO) therapy is a key predictor of patient outcomes. Poor lactate clearance indicates higher mortality risk in pediatric ECMO patients.

Area of Science:

  • Pediatric critical care medicine
  • Cardiovascular surgery
  • Extracorporeal life support

Background:

  • Pediatric extracorporeal membrane oxygenation (ECMO) is a vital therapy for neonates and children with congenital heart defects post-cardiac surgery.
  • Assessing patient outcomes during ECMO is crucial for effective treatment.

Purpose of the Study:

  • To analyze the impact of lactate clearance on outcomes in pediatric patients undergoing ECMO.
  • To identify lactate clearance as a predictive marker for mortality in this population.

Main Methods:

  • Retrospective analysis of 41 pediatric veno-arterial ECMO (vaECMO) patients from January 2006 to December 2016.
  • Recorded blood lactate and lactate clearance at baseline and 3, 6, 9, 12 hours post-ECMO initiation.
  • Utilized Receiver Operating Characteristic (ROC) analysis to determine lactate clearance cut-off levels for mortality prediction.

Main Results:

  • Lactate levels before and during ECMO did not significantly differ between survivors and nonsurvivors.
  • Lactate clearance at 3, 9, and 12 hours post-ECMO initiation was a significant predictor of mortality (p=0.017, p=0.049, p=0.006).
  • Identified cut-off values for lactate clearance at 3.8%, 51%, and 56% were associated with mortality risk.

Conclusions:

  • Dynamic monitoring of lactate clearance after ECMO initiation is valuable for assessing patient outcomes.
  • Inadequate lactate clearance in pediatric ECMO patients is a significant indicator of increased mortality.
  • Lactate clearance serves as an effective tool to evaluate the efficacy of ECMO therapy.

Keywords:
ECMOearly outcomeslactatelactate clearancepediatric ECMO patientssurvival

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