• Ingo Slottosch, Oliver Liakopoulos, Elmar Kuhn, Maximilian Scherner, Antje-Christin Deppe, Anton Sabashnikov, Navid Mader, Yeong-Hoon Choi, Jens Wippermann, and Thorsten Wahlers.
• Department of Cardiothoracic Surgery, University Hospital Magdeburg, Magdeburg, Germany. Electronic address: ingo.slottosch@med.ovgu.de.
• J Crit Care. 2017 Dec 1; 42: 35-41.

PurposeECMO support is an ultimate ratio therapy for patients in refractory cardiogenic shock and is linked to high mortality. We assessed the dynamic characteristics of lactate during ECMO therapy and its predictive role on 30-day mortality.Materials And MethodsData were retrospectively collected in all patients receiving ECMO support longer than 48h for cardiogenic shock from 01/2008 to 12/2016. Blood lactate was recorded before ECMO implantation, at prespecified timepoints during ECMO support, 1h and 6h post-ECMO as well as peak lactate during ECMO and peak within 24h after ECMO support. Statistical analysis included t-test and ROC-curves to identify cut-off levels for lactate levels to predict 30-day mortality.Results139 patients underwent ECMO therapy longer than 48h for refractory cardiogenic shock resulting in a 30-day mortality of 68%. Lactate before ECMO and peak lactate level during ECMO support showed no significant connection to mortality, while lactate and lactate clearance at 24h were predictive for 30-day mortality with cut-off values of 2.15mmol/l and 0.687 respectively.ConclusionsDynamic course of lactate during ECMO therapy is a valuable tool to assess effective circulatory support and is superior to single lactate measurements as a predictive marker for 30-day mortality.Copyright © 2017 Elsevier Inc. All rights reserved.

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