PMID- 38536534
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240330
IS  - 2110-5820 (Print)
IS  - 2110-5820 (Electronic)
IS  - 2110-5820 (Linking)
VI  - 14
IP  - 1
DP  - 2024 Mar 27
TI  - Serial daily lactate levels association with 30-day outcome in cardiogenic shock 
      patients treated with VA-ECMO: a post-hoc analysis of the HYPO-ECMO study.
PG  - 43
LID - 10.1186/s13613-024-01266-6 [doi]
LID - 43
AB  - BACKGROUND: Reliable predictors of outcomes in venoarterial extracorporeal 
      membrane oxygenation (VA-ECMO) therapy are limited. While elevated lactate levels 
      over time have been linked to outcomes in cardiogenic shock (CS), their 
      significance in VA-ECMO-treated patients remains inconclusive. METHODS: We 
      conducted a post hoc analysis of data from the HYPO-ECMO trial, which compared 
      normothermia to moderate hypothermia in CS patients supported by VA-ECMO. We 
      examined daily lactate levels collected over a week to assess their correlation 
      with 30-day mortality. RESULTS: Among the 318 out of 334 patients (95%) with 
      baseline lactate measurements, 66 had normal levels (< 2.2 mmol/l, 21%). No 
      difference was found in lactate course between moderate hypothermia and 
      normothermia groups. Lactate levels were consistently higher in non-survivors at 
      each time point (p = 0.0002). Baseline hyperlactatemia was associated with an 
      increased risk of death (Hazard Ratio [HR]: 1.85 (1.12-3.05), p = 0.016). When 
      considering all time points, lactate levels during the ICU stay were 
      significantly and gradually associated with a higher risk of death (p < 0.0001). 
      In the overall population, a decrease in lactate levels was not linked to 30-day 
      mortality. However, patients with baseline hyperlactatemia exhibited a more 
      significant decrease in lactate levels from day one to seven (p < 0.0001). In 
      this group, survivors had a significantly greater decrease in lactate levels at 
      day 1 compared to non-survivors (63% (48-77) versus 57% (21-75), p = 0.026). 
      Patients experiencing a secondary increase in lactate (24%) had a worse prognosis 
      (Hazard Ratio: 1.78 (1.21-2.61), p = 0.004), regardless of both baseline lactate 
      levels and the occurrence of severe ischemic adverse events (intestinal and/or 
      limb ischemia). CONCLUSIONS: The consistent and significant association between 
      lactate levels, whether assessed at baseline or during ICU treatment, and the 
      risk of mortality underscores the pivotal prognostic relevance of lactate levels 
      in patients with CS undergoing VA-ECMO therapy. The study findings provide some 
      novel insights, regarding the trend profile and the relevance of a second peak 
      during the 7 day period after ECMO start. Trial Registration identifier 
      NCT02754193 registered on 2016-04-12.
CI  - (c) 2024. The Author(s).
FAU - Levy, Bruno
AU  - Levy B
AUID- ORCID: 0000-0002-7630-2908
AD  - Universite de Lorraine, CHRU Nancy, Medecine Intensive et Reanimation, Nancy, 
      France. blevy5463@gmail.com.
AD  - Universite de Lorraine, INSERM U1116, Nancy, France. blevy5463@gmail.com.
FAU - Girerd, Nicolas
AU  - Girerd N
AD  - Universite de Lorraine, CIC-P INSERM 1433, INI-CRCT F-CRIN Network, Nancy, 
      France.
FAU - Baudry, Guillaume
AU  - Baudry G
AD  - Universite de Lorraine, CIC-P INSERM 1433, INI-CRCT F-CRIN Network, Nancy, 
      France.
FAU - Duarte, Kevin
AU  - Duarte K
AD  - Universite de Lorraine, CIC-P INSERM 1433, INI-CRCT F-CRIN Network, Nancy, 
      France.
FAU - Cuau, Samuel
AU  - Cuau S
AD  - Universite de Lorraine, CHRU Nancy, Medecine Intensive et Reanimation, Nancy, 
      France.
FAU - Bakker, Jan
AU  - Bakker J
AD  - NYU Langone and Columbia University Medical Center, New York, USA.
AD  - Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands.
AD  - Pontificia Universidad Catolica de Chile, Santiago, Chile.
FAU - Kimmoun, Antoine
AU  - Kimmoun A
AD  - Universite de Lorraine, CHRU Nancy, Medecine Intensive et Reanimation, Nancy, 
      France.
AD  - Universite de Lorraine, INSERM U1116, Nancy, France.
CN  - HYPO-ECMO trial group and the International ECMO Network (ECMONet)
LA  - eng
SI  - ClinicalTrials.gov/NCT02754193
PT  - Journal Article
DEP - 20240327
PL  - Germany
TA  - Ann Intensive Care
JT  - Annals of intensive care
JID - 101562873
PMC - PMC10973308
OTO - NOTNLM
OT  - Cardiogenic shock
OT  - Extracorporeal Membrane Oxygenation
OT  - Hypothermia
OT  - Lactate
COIS- Dr Baudry reported receiving personal fees from Abbott, AstraZeneca, and 
      Boehringer, outside the submitted work. Pr Girerd reported receiving personal 
      fees from Novartis, Bayer, AstraZeneca, Lilly, Boehringer, and Vifor, outside the 
      submitted work. Pr Levy reported receiving personal fees from Abiomed, Gettinge, 
      Baxter, Novartis, Sanofi, Amomed, and Orion, outside the submitted work. Pr 
      Bakker, Pr Kimmoun, Dr Duarte and Mr Cuau reported no conflict of interest 
      regarding this work.
EDAT- 2024/03/27 18:45
MHDA- 2024/03/27 18:46
PMCR- 2024/03/27
CRDT- 2024/03/27 12:19
PHST- 2023/10/12 00:00 [received]
PHST- 2024/02/17 00:00 [accepted]
PHST- 2024/03/27 18:46 [medline]
PHST- 2024/03/27 18:45 [pubmed]
PHST- 2024/03/27 12:19 [entrez]
PHST- 2024/03/27 00:00 [pmc-release]
AID - 10.1186/s13613-024-01266-6 [pii]
AID - 1266 [pii]
AID - 10.1186/s13613-024-01266-6 [doi]
PST - epublish
SO  - Ann Intensive Care. 2024 Mar 27;14(1):43. doi: 10.1186/s13613-024-01266-6.