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. 2021 Sep 16;18(18):9764.
doi: 10.3390/ijerph18189764.

Prognosis of Hypothermic Patients Undergoing ECLS Rewarming-Do Alterations in Biochemical Parameters Matter?

Hubert Hymczak  1   2 , Paweł Podsiadło  3 , Sylweriusz Kosiński  4 , Mathieu Pasquier  5 , Konrad Mendrala  6 , Damian Hudziak  7 , Radosław Gocoł  7 , Dariusz Plicner  8 , Tomasz Darocha  6
Affiliations

Prognosis of Hypothermic Patients Undergoing ECLS Rewarming-Do Alterations in Biochemical Parameters Matter?

Hubert Hymczak et al. Int J Environ Res Public Health. .

Abstract

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 °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 °C, and at 2 and 4 h after Tc 30 °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 °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 °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 °C is also associated with a poor prognosis.

Keywords: ECLS; accidental hypothermia; lactate; lactate kinetics; rewarming.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The mean values of blood pH, PaCO2, PaO2, HCO3, BE, and Hgb values are plotted at different time points. The bars represent a 95% confidence interval. T1—time at ECMO implantation, T2—time obtained Tc 30 °C, T3—2 h after Tc 30 °C, and T4—4 h after Tc 30 °C.
Figure 2
Figure 2
Receiver operating characteristic curve (ROC) analysis for the occurrence of death in relation to the lactate concentration at time point T4. AUROC (area under the receiver operating characteristic curve)—0.812. Standard error—0.065. p < 0.001. 95% CI—0.684–0.939. Cut-off point (95% CI) > 12.55. Sensitivity (%) of cut-off value—85. Specificity (%) of cut-off value—65.
See this image and copyright information in PMC

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