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The following is a summary of “Serial daily lactate levels association with 30-day outcome in cardiogenic shock patients treated with VA-ECMO: a post-hoc analysis of the HYPO-ECMO study,” published in the March 2024 issue of Critical Care by Levy et al.

Researchers conducted a retrospective study to assess how changes in lactate levels over time predict outcomes for cardiogenic shock (CS) patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) therapy.

They analyzed data from the HYPO-ECMO trial, where normothermia was compared to moderate hypothermia in CS patients on VA-ECMO. Daily lactate levels were assessed over a week to correlate with 30-day mortality.

The results showed 334 patients, 318 (95%) had baseline lactate measurements, with 66 having normal levels (< 2.2 mmol/l, 21%). Lactate trajectories didn’t differ between moderate hypothermia and normothermia groups. Non-survivors consistently showed higher lactate levels at all times (P=0.0002). Baseline hyperlactatemia correlated with an increased risk of death (HR: 1.85 (1.12–3.05), P=0.016). ICU stay, lactate levels showed a significant and gradual association with heightened mortality risk (P<0.0001). A reduction in lactate levels didn’t correlate with 30-day mortality in the entire population. Patients with baseline hyperlactatemia demonstrated a more substantial decline in lactate levels from day one to seven (P<0.0001). Among this cohort, survivors exhibited a significantly greater decrease in lactate levels on day 1 compared to non-survivors (63% (48–77) vs. 57% (21–75), P=0.026). Patients experiencing a secondary rise in lactate (24%) faced a worse prognosis (HR: 1.78 (1.21–2.61), P=0.004), irrespective of both baseline lactate levels and the occurrence of severe ischemic adverse events (intestinal and/or limb ischemia).

Investigators concluded that consistently high lactate levels, measured both initially and throughout ICU care, predict mortality in CS patients receiving VA-ECMO therapy, highlighting lactate’s crucial role in prognosis.

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01266-6