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Peak Blood Lactate at 24 h after ECMO Can Predict 30-day Mortality in Infants after Complex Cardiac Surgery
Fanwei Meng1, Jianchao Li2, Weijie Liang3
1Department of Cardiac Surgery, Fuwai Central China Cardiovascular Hospital, Henan Provincial People's Hospital, 450000 Zhengzhou, Henan, China. 1114926559@qq.com.
Insights
Peak blood lactate levels at 24 hours after extracorporeal membrane oxygenation (ECMO) can predict 30-day mortality in infants undergoing complex cardiac surgery. A lactate level of 10.2 mmol/L is the best cutoff for predicting survival outcomes.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Biomarkers in Surgery
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support measure for infants with severe cardiac dysfunction post-surgery.
- Predicting mortality risk in these vulnerable patients is crucial for clinical management.
Purpose of the Study:
- To investigate the predictive value of peak blood lactate levels at 24 hours after ECMO for 30-day mortality in infants.
- To identify key risk factors influencing prognosis in infants after complex cardiac surgery requiring ECMO.
Main Methods:
- A retrospective study of 28 infants treated with ECMO after complex congenital heart disease surgery.
- Analysis of 30-day survival and risk factors using Cox regression.
- Evaluation of peak blood lactate at 24 hours post-ECMO as a predictive marker.
Main Results:
- Infants who did not survive showed significantly higher peak blood lactate levels, liver dysfunction, and multiple organ dysfunction syndrome (MODS) compared to survivors.
- Peak blood lactate at 24 hours post-ECMO (HR=1.074) and MODS (HR=4.120) were identified as significant risk factors for mortality.
- A peak blood lactate cutoff of 10.2 mmol/L demonstrated good predictive performance (AUC=0.770, sensitivity=94.1%, specificity=54.5%) for 30-day mortality.
Conclusions:
- Peak blood lactate at 24 hours after ECMO is a valuable predictor of 30-day mortality in infants following complex cardiac surgery.
- The established cutoff value of 10.2 mmol/L for peak blood lactate can aid in risk stratification and clinical decision-making.
Objective:
Peak blood lactate at 24 h after extracorporeal membrane oxygenation (ECMO) can predict 30-day mortality in infants after complex cardiac surgery.
Methods:
Twenty-eight infants with ECMO after complex congenital heart disease surgery were selected from March 2019 to March 2022 in our hospital. The infants were divided into survival group (n = 11) and non-survival group (n = 17) according to 30-day survival after discharge from hospital. The risk factors at 30-day mortality after discharge were analyzed by Cox regression analysis.
Results:
When compared to the non-survival group, there were significant differences in peak blood lactate at 24 h after ECMO, liver dysfunction and multiple organ dysfunction syndrome (MODS) in the survival group (p < 0.05). Cox regression analysis showed that peak blood lactate at 24 h after ECMO (HR = 1.074, 95% CI: 1.005-1.149, p = 0.036) and MODS (HR = 4.120, 95% CI: 1.373-12.362, p = 0.012) were related risk factors affecting the prognosis of infants. The best cutoff value for the peak blood lactate at 24 h after ECMO was 10.2 mmol/L. The area under the curve (AUC) for predicting the 30-day survival rate of the ECMO assisted infants after discharge from hospital was 0.770 (95% CI: 0.592-0.948, p = 0.018), with a sensitivity of 94.1% and specificity of 54.5%.
Conclusion:
The peak blood lactate at 24 h after ECMO can predict the 30-day mortality after discharge of infants treated with ECMO after complex cardiac surgery. The best cut-off value for peak blood lactate at 24 h after ECMO was 10.2 mmol/L.
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