Comparison of the predictive ability of lactate and central venous blood gas in pediatric venoarterial mode extracorporeal membrane oxygenation outcome
Abstract
Background
This study aims to compare lactate and central venous blood gas in the prediction of outcome in pediatric venoarterial mode extracorporeal membrane oxygenation (V-A ECMO).
Method
This was a retrospective observational study conducted on patients undergoing V-A mode ECMO care in the pediatric intensive care unit (PICU) of a tertiary medical center in Taiwan. Patients under 18 years of age undergoing V-A ECMO from January 2009 to April 2019 were included in this study.
Results
This study consisted of 47 children who received V-A mode ECMO with an overall weaning rate of 66.0%. The mean age was 5.5 years and mean ECMO duration was 11.6 days. Successful weaning group had significantly lower lactate levels at initial (58.7 ± 47.0 mg/dL vs. 108.0 ± 55.3 mg/dL, p = 0.003), 0–12 h (37.8 ± 29.0 mg/dL vs. 83.5 ± 60.0 mg/dL, p = 0.001), 12–24 h (29.4 ± 26.9 mg/dL vs. 69.1 ± 59.1 mg/dL, p = 0.003), and 24–48 h (25.9 ± 25.4 mg/dL vs. 60.9 ± 69.4 mg/dL, p = 0.017) after ECMO initiation; however, the central venous blood gas including pH, HCO3, CO2, bass excess (BE), and O2 saturation (Scv O2) showed no significant difference. The favorable outcome group had significantly lower lactate levels at 0–12 h (32.8 ± 26.3 mg/dL vs. 71.3 ± 53.3 mg/dL, p = 0.005), 12–24 h (20.7 ± 10.2 mg/dL vs. 61.9 ± 53.5 mg/dL, p = 0.002), and 24–48 h (19.0 ± 10.0 mg/dL vs. 54.2 ± 60.5, p = 0.014); however, the HCO3 levels (26.2 ± 4.5 mmol/L vs. 22.9 ± 6.8 mmol/L, p = 0.042) and BE (2.2 ± 5.4 vs. -2.2 ± 8.5, p = 0.047) were significantly higher at 12–24 h. In multivariate logistic regression, 12–24 h lactate value was an independent factor for unfavorable outcomes (p = 0.015, odds ratio [OR] = 1.1, 95% confidence interval [CI] = 1.01–1.10) with the best cut-off value of 48.6 mg/dL (sensitivity 48%, specificity 100%).
Conclusion
Lactate has better outcome prediction than central venous blood gas in pediatric V-A mode ECMO. The lactate value 12–24 h after ECMO initiation was an independent factor for unfavorable outcomes.