Lactate and lactate clearance as predictors of one-year survival in extracorporeal cardiopulmonary resuscitation – An international, multicentre cohort study
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Lactate and lactate clearance as predictors of one-year survival in extracorporeal cardiopulmonary resuscitation – An international, multicentre cohort study. / Thevathasan, Tharusan; Gregers, Emilie; Mørk, Sivagowry Rasalingam; Degbeon, Sêhnou; Linde, Louise; Andreasen, Jo Bønding; Smerup, Morten; Møller, Jacob Eifer; Hassager, Christian; Laugesen, Helle; Dreger, Henryk; Brand, Anna; Balzer, Felix; Landmesser, Ulf; Terkelsen, Christian Juhl; Flensted Lassen, Jens; Skurk, Carsten; Søholm, Helle.
I: Resuscitation, Bind 198, 110149, 2024.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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T1 - Lactate and lactate clearance as predictors of one-year survival in extracorporeal cardiopulmonary resuscitation – An international, multicentre cohort study
AU - Thevathasan, Tharusan
AU - Gregers, Emilie
AU - Mørk, Sivagowry Rasalingam
AU - Degbeon, Sêhnou
AU - Linde, Louise
AU - Andreasen, Jo Bønding
AU - Smerup, Morten
AU - Møller, Jacob Eifer
AU - Hassager, Christian
AU - Laugesen, Helle
AU - Dreger, Henryk
AU - Brand, Anna
AU - Balzer, Felix
AU - Landmesser, Ulf
AU - Terkelsen, Christian Juhl
AU - Flensted Lassen, Jens
AU - Skurk, Carsten
AU - Søholm, Helle
N1 - Publisher Copyright: © 2024 The Author(s)
PY - 2024
Y1 - 2024
N2 - Aim: Extracorporeal cardiopulmonary resuscitation (ECPR) can be considered in selected patients with refractory cardiac arrest. Given the risk of patient futility and high resource utilisation, identifying ECPR candidates, who would benefit from this therapy, is crucial. Previous ECPR studies investigating lactate as a potential prognostic marker have been small and inconclusive. In this study, it was hypothesised that the lactate level (immediately prior to initiation of ECPR) and lactate clearance (within 24 hours after ECPR initiation) are predictors of one-year survival in a large, multicentre study cohort of ECPR patients. Methods: Adult patients with refractory cardiac arrest at three German and four Danish tertiary cardiac care centres between 2011 and 2021 were included. Pre-ECPR lactate and 24-hour lactate clearance were divided into three equally sized tertiles. Multivariable logistic regression analyses and Kaplan-Meier analyses were used to analyse survival outcomes. Results: 297 adult patients with refractory cardiac arrest were included in this study, of which 65 (22%) survived within one year. The pre-ECPR lactate level and 24-hour lactate clearance were level-dependently associated with one-year survival: OR 5.40 [95% CI 2.30–13.60] for lowest versus highest pre-ECPR lactate level and OR 0.25 [95% CI 0.09–0.68] for lowest versus highest 24-hour lactate clearance. Results were confirmed in Kaplan-Meier analyses (each p log rank < 0.001) and subgroup analyses. Conclusion: Pre-ECPR lactate levels and 24 hour-lactate clearance after ECPR initiation in patients with refractory cardiac arrest were level-dependently associated with one-year survival. Lactate is an easily accessible and quickly available point-of-care measurement which might be considered as an early prognostic marker when considering initiation or continuation of ECPR treatment.
AB - Aim: Extracorporeal cardiopulmonary resuscitation (ECPR) can be considered in selected patients with refractory cardiac arrest. Given the risk of patient futility and high resource utilisation, identifying ECPR candidates, who would benefit from this therapy, is crucial. Previous ECPR studies investigating lactate as a potential prognostic marker have been small and inconclusive. In this study, it was hypothesised that the lactate level (immediately prior to initiation of ECPR) and lactate clearance (within 24 hours after ECPR initiation) are predictors of one-year survival in a large, multicentre study cohort of ECPR patients. Methods: Adult patients with refractory cardiac arrest at three German and four Danish tertiary cardiac care centres between 2011 and 2021 were included. Pre-ECPR lactate and 24-hour lactate clearance were divided into three equally sized tertiles. Multivariable logistic regression analyses and Kaplan-Meier analyses were used to analyse survival outcomes. Results: 297 adult patients with refractory cardiac arrest were included in this study, of which 65 (22%) survived within one year. The pre-ECPR lactate level and 24-hour lactate clearance were level-dependently associated with one-year survival: OR 5.40 [95% CI 2.30–13.60] for lowest versus highest pre-ECPR lactate level and OR 0.25 [95% CI 0.09–0.68] for lowest versus highest 24-hour lactate clearance. Results were confirmed in Kaplan-Meier analyses (each p log rank < 0.001) and subgroup analyses. Conclusion: Pre-ECPR lactate levels and 24 hour-lactate clearance after ECPR initiation in patients with refractory cardiac arrest were level-dependently associated with one-year survival. Lactate is an easily accessible and quickly available point-of-care measurement which might be considered as an early prognostic marker when considering initiation or continuation of ECPR treatment.
KW - Acute myocardial infarction
KW - Cardiac arrest
KW - Extracorporeal cardiopulmonary resuscitation
KW - Lactate
KW - Veno-arterial extracorporeal membrane oxygenation
U2 - 10.1016/j.resuscitation.2024.110149
DO - 10.1016/j.resuscitation.2024.110149
M3 - Journal article
C2 - 38403182
AN - SCOPUS:85187668836
VL - 198
JO - Resuscitation
JF - Resuscitation
SN - 0300-9572
M1 - 110149
ER -
ID: 387031158