Hyperlactatemia and poor outcome After postcardiotomy veno-arterial extracorporeal membrane oxygenation: An individual patient data meta-Analysis

• Published in: Perfusion 2024-07, Vol.39 (5), p.956-965
• Main Authors: Biancari, Fausto, Kaserer, Alexander, Perrotti, Andrea, Ruggieri, Vito G, Cho, Sung-Min, Kang, Jin Kook, Dalén, Magnus, Welp, Henryk, Jónsson, Kristján, Ragnarsson, Sigurdur, Hernández Pérez, Francisco J, Gatti, Giuseppe, Alkhamees, Khalid, Loforte, Antonio, Lechiancole, Andrea, Rosato, Stefano, Spadaccio, Cristiano, Pettinari, Matteo, Mariscalco, Giovanni, Mäkikallio, Timo, Sahli, Sebastian D, L’Acqua, Camilla, Arafat, Amr A, Albabtain, Monirah A, AlBarak, Mohammed M, Laimoud, Mohamed, Djordjevic, Ilija, Krasivskyi, Ihor, Samalavicius, Robertas, Puodziukaite, Lina, Alonso-Fernandez-Gatta, Marta, Spahn, Donat R, Fiore, Antonio
• Format: Article
• Language: English
• Subjects: Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; Data analysis; Decision making; Extracorporeal membrane oxygenation; Extracorporeal Membrane Oxygenation - adverse effects; Extracorporeal Membrane Oxygenation - methods; Female; Hospital Mortality; Hospitals; Humans; Hyperlactatemia; Hyperlactatemia - blood; Hyperlactatemia - etiology; Lactic acid; Lactic Acid - blood; Male; Medicin och hälsovetenskap; Membranes; Meta-analysis; Middle Aged; Mortality; Oxygenation; Patients; Regression analysis; Regression models
• ISSN: 0267-6591; 1477-111X; 1477-111X
• DOI: 10.1177/02676591231170978

Introduction Postcardiotomy veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) is associated with significant mortality. Identification of patients at very high risk for death is elusive and the decision to initiate V-A-ECMO is based on clinical judgment. The prognostic impact of pre-V-A-ECMO arterial lactate level in these critically ill patients has been herein evaluated. Methods A systematic review was conducted to identify studies on postcardiotomy VA-ECMO for the present individual patient data meta-analysis. Results Overall, 1269 patients selected from 10 studies were included in this analysis. Arterial lactate level at V-A-ECMO initiation was increased in patients who died during the index hospitalization compared to those who survived (9.3 vs 6.6 mmol/L, p < 0.0001). Accordingly, in hospital mortality increased along quintiles of pre-V-A-ECMO arterial lactate level (quintiles: 1, 54.9%; 2, 54.9%; 3, 67.3%; 4, 74.2%; 5, 82.2%, p < 0.0001). The best cut-off for arterial lactate was 6.8 mmol/L (in-hospital mortality, 76.7% vs. 55.7%, p < 0.0001). Multivariable multilevel mixed-effect logistic regression model including arterial lactate level significantly increased the area under the receiver operating characteristics curve (0.731, 95% CI 0.702–0.760 vs 0.679, 95% CI 0.648–0.711, DeLong test p < 0.0001). Classification and regression tree analysis showed the in-hospital mortality was 85.2% in patients aged more than 70 years with pre-V-A-ECMO arterial lactate level ≥6.8 mmol/L. Conclusions Among patients requiring postcardiotomy V-A-ECMO, hyperlactatemia was associated with a marked increase of in-hospital mortality. Arterial lactate may be useful in guiding the decision-making process and the timing of initiation of postcardiotomy V-A-ECMO.