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Vol. 75. Issue 7.
Pages 595-603 (July 2022)
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Vol. 75. Issue 7.
Pages 595-603 (July 2022)
Original article
Lactate levels as a prognostic predict in cardiogenic shock under venoarterial extracorporeal membrane oxygenation support
Cinética del lactato para el pronóstico en el shock cardiogénico asistido con oxigenador extracorpóreo de membrana venoarterial
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Jorge Martínez-Solanoa,b,c, Iago Sousa-Casasnovasa,b,c, José María Bellón-Canoc, Jorge García-Carreñoa,b,c, Miriam Juárez-Fernándeza,b,c, Felipe Díez-Delhoyoa,b,c, Ricardo Sanz-Ruiza,b,c, Carolina Devesa-Corderoa,b,c, Jaime Elízaga-Corralesa,b,c, Francisco Fernández-Avilésa,b,c,d, Manuel Martínez-Sellésa,b,c,d,e,
Corresponding author
mmselles@secardiologia.es

Corresponding author at: Corresponding author: Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain.
a Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
b Instituto de Investigación Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain
c Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
d Facultad de Medicina, Universidad Complutense, Madrid, Spain
e Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, Madrid, Spain
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Abstract
Introduction and objectives

Lactate and its evolution are associated with the prognosis of patients in shock, although there is little evidence in those assisted with an extracorporeal venoarterial oxygenation membrane (VA-ECMO). Our objective was to evaluate its prognostic value in cardiogenic shock assisted with VA-ECMO.

Methods

Study of patients with cardiogenic shock treated with VA-ECMO for medical indication between July 2013 and April 2021. Lactate clearance was calculated: [(initial lactate − 6 h lactate) / initial lactate × exact time between both determinations].

Results

From 121 patients, 44 had acute myocardial infarction (36.4%), 42 implant during cardiopulmonary resuscitation (34.7%), 14 pulmonary embolism (11.6%), 14 arrhythmic storm (11.6%), and 6 fulminant myocarditis (5.0%). After 30 days, 60 patients (49.6%) died, mortality was higher for implant during cardiopulmonary resuscitation than for implant in spontaneous circulation (30 of 42 [71.4%] vs 30 of 79 [38.0%], P=.030). Preimplantation GPT and lactate (both baseline, at 6hours, and clearance) were independently associated with 30-day mortality. The regression models that included lactate clearance had a better predictive capacity for survival than the ENCOURAGE and ECMO-ACCEPTS scores, with the area under the ROC curve being greater in the model with lactate at 6 h.

Conclusions

Lactate (at baseline, 6h, and clearance) is an independent predictor of prognosis in patients in cardiogenic shock supported by VA-ECMO, allowing better risk stratification and predictive capacity.

Keywords:
Lactate
Cardiogenic shock
VA-ECMO
Lactate clearance
Mechanical circulatory support
Abbreviations:
VA-ECMO
Resumen
Introducción y objetivos

El lactato y su evolución se asocian con el pronóstico de los pacientes en shock, si bien es escasa la evidencia en aquellos asistidos con oxigenador extracorpóreo de membrana venoarterial (ECMO-VA). Nuestro objetivo es evaluar su valor pronóstico en shock cardiogénico asistido con ECMO-VA.

Métodos

Estudio de pacientes tratados con ECMO-VA por shock cardiogénico de indicación médica entre julio de 2013 y abril de 2021. Se calculó el aclaramiento de lactato: (lactato inicial − lactato 6 h) / lactato inicial × tiempo exacto entre ambas determinaciones.

Resultados

De 121 pacientes, 44 (36,4%) tenían infarto agudo de miocardio; 42 (34,7%), implante intraparada; 14 (11,6%), tromboembolia pulmonar, 14 (11,6%), tormenta arrítmica y 6 (5,0%), miocarditis fulminante. A los 30 días habían fallecido 60 pacientes (49,6%); la mortalidad fue mayor con el implante intraparada que con el implante en circulación espontánea (30 [71,4%] de 42 frente a 30 [38,0%] de 79; p=0,030). Se asociaron de manera independiente con la mortalidad a 30 días la alanina aminotransferasa (ALT) antes del implante y el lactato (tanto basal como a las 6 h y el aclaramiento). Los modelos de regresión que incluían el lactato presentaron mejor capacidad predictiva de la supervivencia que las puntuaciones ENCOURAGE y ECMO-ACCEPTS, con mayor área bajo la curva ROC en el modelo con lactato a las 6 h.

Conclusiones

El lactato (basal y a las 6 h y el aclaramiento) es un predictor independiente para el pronóstico de los pacientes en shock cardiogénico asistidos con ECMO-VA que facilita una mejor estratificación del riesgo y tiene una capacidad predictiva superior.

Palabras clave:
Lactato
Shock cardiogénico
ECMO-VA
Aclaramiento de lactato
Asistencia circulatoria mecánica

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