Prognosis of Hypothermic Patients Undergoing ECLS Rewarming-Do Alterations in Biochemical Parameters Matter? - Hymczak, H.; Podsiadlo, P.; Kosinski, S.; Pasquier, M.; Mendrala, K.; Hudziak, D.; Gocol, R.; Plicner, D.; Darocha, T. (Int J Environ Res Public Health, 2021)
BACKGROUND: While ECLS is a highly invasive procedure, the identification of patients with a potentially good prognosis is of high importance. The aim of this study was to analyse changes in the acid-base balance parameters and lactate kinetics during the early stages of ECLS rewarming to determine predictors of clinical outcome. METHODS: This single-centre retrospective study was conducted at the Severe Hypothermia Treatment Centre at John Paul II Hospital in Krakow, Poland. Patients >/=18 years old who had a core temperature (Tc) < 30 degrees C and were rewarmed with ECLS between December 2013 and August 2018 were included. Acid-base balance parameters were measured at ECLS implantation, at Tc 30 degrees C, and at 2 and 4 h after Tc 30 degrees C. The alteration in blood lactate kinetics was calculated as the percent change in serum lactate concentration relative to the baseline. RESULTS: We included 50 patients, of which 36 (72%) were in cardiac arrest. The mean age was 56 +/- 15 years old, and the mean Tc was 24.5 +/- 12.6 degrees C. Twenty-one patients (42%) died. Lactate concentrations in the survivors group were significantly lower than in the non-survivors at all time points. In the survivors group, the mean lactate concentration decreased -2.42 +/- 4.49 mmol/L from time of ECLS implantation until 4 h after reaching Tc 30 degrees C, while in the non-survivors' group (p = 0.024), it increased 1.44 +/- 6.41 mmol/L. CONCLUSIONS: Our results indicate that high lactate concentration is associated with a poor prognosis for hypothermic patients undergoing ECLS rewarming. A decreased value of lactate kinetics at 4 h after reaching 30 degrees C is also associated with a poor prognosis.
Keywords: journalArticle; *Extracorporeal Membrane Oxygenation; *Hypothermia; Adolescent; Adult; Aged; Ecls; Humans; Lactic Acid; Middle Aged; Retrospective Studies; Rewarming; accidental hypothermia; lactate; lactate kinetics