Dynamic Early Postreperfusion Physiology Is Associated With Organ Recovery After Extracorporeal Cardiopulmonary Resuscitation

Prognostication after extracorporeal cardiopulmonary resuscitation (ECPR) predominantly relies on characteristics available before or at initiation of extracorporeal support. We investigated whether the early metabolic response to extracorporeal reperfusion provides complementary information on subsequent recovery. We retrospectively analyzed 91 patients with refractory out-of-hospital cardiac arrest treated with ECPR. Lactate was assessed before and 12 h after extracorporeal membrane oxygenation (ECMO) initiation. Outcomes included in-hospital mortality, successful ECMO weaning, cerebral edema/hypoxic brain injury, and favorable neurological survival. Associations were adjusted for low-flow duration. Twelve hour lactate was lower in survivors than nonsurvivors (5.45 vs. 9.04 mmol/L; p = 0.002), whereas prereperfusion lactate did not differ. In paired measurements (n = 38), mortality discrimination increased from an area under the receiver operating characteristic curve (AUC) of 0.47 before reperfusion to 0.80 at 12 h. Each 5 mmol/L higher 12 h lactate was associated with mortality (odds ratio [OR] = 2.73), lower odds of ECMO weaning (OR = 0.44), and cerebral edema/hypoxic injury (OR = 2.07) after low-flow adjustment. Early metabolic response after extracorporeal reperfusion was associated with survival and both circulatory and cerebral recovery. Dynamic post-reperfusion physiology may provide complementary information beyond static pre-reperfusion assessment.