TY - JOUR 
A1 - Martínez Solano, Jorge
AU - Sousa Casasnovas, Iago
AU - Bellón Cano, José María
AU - García Carreño, Jorge
AU - Juárez Fernández, Miriam
AU - Díez Delhoyo, Felipe
AU - Sanz Ruiz, Ricardo
AU - Devesa Cordero, Carolina
AU - Elízaga Corrales, Jaime
AU - Fernández Avilés, Francisco
AU - Martínez Sellés Oliveria Soares, Manuel
T1 - Lactate levels as a prognostic predict in cardiogenic shock under venoarterial extracorporeal membrane oxygenation support
Y1 - 2022
SN - 1885-5857
UR - http://hdl.handle.net/11268/11538
AB - 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.
KW - Choque cardiogénico
KW - Ácido láctico
KW - Signos y síntomas
KW - Enfermedad cardiovascular
KW - Bioquímica
KW - Efectos fisiológicos
LA - eng
ER -