• Fernando Luís Scolari, Daniel Schneider, Débora Vacaro Fogazzi, Miguel Gus, Marciane Maria Rover, Marcely Gimenes Bonatto, Gustavo Neves de Araújo, André Zimerman, Daniel Sganzerla, Lívia Adams Goldraich, Cassiano Teixeira, Gilberto Friedman, Carisi Anne Polanczyk, Luis Eduardo Rohde, Regis Goulart Rosa, and Rodrigo Vugman Wainstein.
• Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos 630, 10º andar, Porto Alegre, RS, 90035-001, Brazil. fernando.scolari@hmv.org.br.
• Bmc Cardiovasc Disor. 2020 Nov 24; 20 (1): 496.

BackgroundTo evaluate the prognostic value of peak serum lactate and lactate clearance at several time points in cardiogenic shock treated with temporary mechanical circulatory support (MCS) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) or Impella CP®.MethodsSerum lactate and clearance were measured before MCS and at 1 h, 6 h, 12 h, and 24 h post-MCS in 43 patients at four tertiary-care centers in Southern Brazil. Prognostic value was assessed by univariable and multivariable analysis and receiver operating characteristic (ROC) curves for 30-day mortality.ResultsVA-ECMO was the most common MCS modality (58%). Serum lactate levels at all time points and lactate clearance after 6 h were associated with mortality on unadjusted and adjusted analyses. Lactate levels were higher in non-survivors at 6 h, 12 h, and 24 h after MCS. Serum lactate > 1.55 mmol/L at 24 h was the best single prognostic marker of 30-day mortality [area under the ROC curve = 0.81 (0.67-0.94); positive predictive value = 86%). Failure to improve serum lactate after 24 h was associated with 100% mortality.ConclusionsSerum lactate was an important prognostic biomarker in cardiogenic shock treated with temporary MCS. Serum lactate and lactate clearance at 24 h were the strongest independent predictors of short-term survival.

32 keywords...

hide…