To examine whether values of arterial base excess or lactate taken 3 h after starting ECLS indicate poor prognosis and if this can be used as a screening tool to follow Extra Corporeal Life Support after Out Hospital Cardiac Arrest due to acute coronary syndrome.
Single Centre retrospective observational study.
University teaching hospital general adult intensive care unit.
15 consecutive patients admitted to the intensive care unit after refractory Out Hospital Cardiac Arrest due to acute coronary syndrome treated by Extra Corporeal Life Support.
Arterial base excess and lactate concentrations were measured immediately after starting ECLS and every 3 h after.
Both base excess and arterial lactate measured 3 h after starting ECLS effectively predict multiorgan failure occurrence and mortality in the following 21 h (area under the curve on receiver operating characteristic analysis of 0.97, 0.95 respectively). The best predictive values were obtained with a base excess level measured 3 h after starting ECLS of less than −10 mmol/l and lactate concentrations greater than 12 mmol/l. The combination of these two markers measured 3 h after starting ECLS predicted multiorgan failure occurrence and mortality in the following 21 h with a sensitivity of 70% and a specificity of 100%.
Combination of base excess and lactate, measured 3 h after starting ECLS, can be used to predict multiorgan failure occurrence and mortality in the following 21 h in patients admitted to an intensive care unit for refractory Out Hospital Cardiac Arrest due to acute coronary syndrome treated by Extra Corporeal Life Support. These parameters can be obtained simply and rapidly and help in the decision process to continue ECLS for refractory CA.
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- Extracorporeal life support for treating cardiac arrest.Bull Acad Natl Med. 2011; 195 (discussion 33–6): 2025-2033
- Extracorporeal life support for cardiogenic shock or cardiac arrest due to acute coronary syndrome.Ann Thorac Surg. 2012; 94: 1-7
- Extracorporeal life support following out-of-hospital refractory cardiac arrest.Crit Care (London, England). 2011; 15: R29
- Successful treatment of refractory cardiac arrest by emergency physicians using pre-hospital ECLS.Resuscitation. 2012; 83: e177-e178
- Safety and feasibility of prehospital extra corporeal life support implementation by non-surgeons for out-of-hospital refractory cardiac arrest.Resuscitation. 2013; 84: 1525-1529
- Usefulness of routine laboratory parameters in the decision to treat refractory cardiac arrest with extracorporeal life support.Resuscitation. 2011; 82: 1154-1161
- Guidelines for indications for the use of extracorporeal life support in refractory cardiac arrest. French Ministry of Health.Ann Fr Anesth Réanim. 2009; 28: 182-190
- A new Simplified Acute Physiology Score A. (SAPS. II) based on a European/North American multicenter study.JAMA. 1993; 270: 2957-2963
- Base deficit is superior to pH in evaluating clearance of acidosis after traumatic shock.J Trauma. 1998; 44: 114-118
- Early physiologic predictors of injury severity and death in blunt multiple trauma.Arch Surg. 1990; 125: 498-508
- Oxygen debt and metabolic acidemia as quantitative predictors of mortality and the severity of the ischemic insult in hemorrhagic shock.Crit Care Med. 1991; 19: 231-243
- Base deficit as a sensitive indicator of compensated shock and tissue oxygen utilization.Surg Gynecol Obstet. 1991; 173: 473-476
- Base deficit in the elderly: a marker of severe injury and death.J Trauma. 1998; 45: 873-877
- Base excess and lactate as prognostic indicators for patients admitted to intensive care.Intensive Care Med. 2001; 27: 74-83
- Lactic acidosis in critical illness.Crit Care Med. 1992; 20: 80-93
- Single-center experience with extracorporeal life support in 103 nonpostcardiotomy patients.Artif Organs. 2013; 37: 150-156
- Gastric intramucosal pH. A better predictor of multiorgan dysfunction syndrome and death than oxygen-derived variables in patients with sepsis.Chest. 1993; 104: 225-229
- Blood pressure and arterial lactate level are early indicators of short-term survival in human septic shock.Intensive Care Med. 1996; 22: 17-25
- Combined measurements of blood lactate concentrations and gastric intramucosal pH in patients with severe sepsis.Crit Care Med. 1995; 23: 1184-1193
- Blood lactate levels are superior to oxygen-derived variables in predicting outcome in human septic shock.Chest. 1991; 99: 956-962
- Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock).Circulation. 1970; 41: 989-1001
- Blood lactate in the prognosis of various forms of shock.Ann Surg. 1971; 173: 308-313
- The association between blood lactate concentration on admission, duration of cardiac arrest, and functional neurological recovery in patients resuscitated from ventricular fibrillation.Intensive Care Med. 1997; 23: 1138-1143
- The thin line between life and death.Intensive Care Med. 2007; 33: 751-754
- CPR with assisted extracorporeal life support.Lancet. 2008; 372 (author reply 1879–80): 1879
- Cost-utility analysis of salvage cardiac extracorporeal membrane oxygenation in children.J Thorac Cardiovasc Surg. 2005; 129: 1084-1090
- Bleeding events in refractory cardiac arrest treated with extracorporeal membrane oxygenation – a single centre experience.Resuscitation. 2013; 84: e119
- Recommandations sur les indications de l’assistance circulatoire dans le traitement des arrêts cardiaques réfractaires.Paediatr Child Health, 2008
- Hyperoxia: a review of the risks and benefits in adult cardiac surgery.J Extra Corpor Technol. 2012; 44: 241-249
Published online: October 22, 2014
Accepted: October 13, 2014
Received in revised form: October 1, 2014
Received: May 18, 2014
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2014.10.012.
© 2014 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.