Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Prediction of 6-Month Mortality Using Pre-Extracorporeal Membrane Oxygenation Lactate in Patients with Acute Coronary Syndrome Undergoing Veno-Arterial-Extracorporeal Membrane Oxygenation

  • Kim, Eunchong (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Sodirzhon-Ugli, Nodirbek Yuldashev (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Kim, Do Wan (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Lee, Kyo Seon (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Lim, Yonghwan (Department of Cardiology, Chonnam National University Medical School) ;
  • Kim, Min-Chul (Department of Cardiology, Chonnam National University Medical School) ;
  • Cho, Yong Soo (Department of Emergency, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Jung, Yong Hun (Department of Emergency, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Jeung, Kyung Woon (Department of Emergency, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Cho, Hwa Jin (Department of Pediatrics, Chonnam National University Children's Hospital, Chonnam National University Medical School) ;
  • Jeong, In Seok (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School)
  • Received : 2021.10.13
  • Accepted : 2021.12.29
  • Published : 2022.04.05
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Abstract

Background: The effectiveness of extracorporeal membrane oxygenation (ECMO) for patients with refractory cardiogenic shock or cardiac arrest is being established, and serum lactate is well known as a biomarker of end-organ perfusion. We evaluated the efficacy of pre-ECMO lactate for predicting 6-month survival in patients with acute coronary syndrome (ACS) undergoing ECMO. Methods: We reviewed the medical records of 148 patients who underwent veno-arterial (VA) ECMO for ACS between January 2015 and June 2020. These patients were divided into survivors and non-survivors based on 6-month survival. All clinical data before and during ECMO were compared between the 2 groups. Results: Patients' mean age was 66.0±10.5 years, and 116 (78.4%) were men. The total survival rate was 45.9% (n=68). Cox regression analysis showed that the pre-ECMO lactate level was an independent predictor of 6-month mortality (hazard ratio, 1.210; 95% confidence interval [CI], 1.064-1.376; p=0.004). The area under the receiver operating characteristic curve of pre-ECMO lactate was 0.64 (95% CI, 0.56-0.72; p=0.002; cut-off value=9.8 mmol/L). Kaplan-Meier survival analysis showed that the cumulative survival rate at 6 months was significantly higher among patients with a pre-ECMO lactate level of 9.8 mmol/L or less than among those with a level exceeding 9.8 mmol/L (57.3% vs. 31.8%, p=0.0008). Conclusion: A pre-ECMO lactate of 9.8 mmol/L or less may predict a favorable outcome at 6 months in ACS patients undergoing VA-ECMO. Further research aiming to improve the accuracy of predictions of reversibility in patients with high pre-ECMO lactate levels is essential.

Keywords

Acknowledgement

This study was supported by the National Research Foundation of Korea (NRF-2019R1D1A3A03103899, NRF-2021R1I1A3047390).

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