Base excess and lactate as prognostic indicators for patients treated by extra corporeal life support after out hospital cardiac arrest due to acute coronary syndrome

Abstract

ObjectiveTo examine whether values of arterial base excess or lactate taken 3h after starting ECLS indicate poor prognosis and if this can be used as a screening tool to follow Extra Corporeal Life Support after Out Hospital Cardiac Arrest due to acute coronary syndrome. DesignSingle Centre retrospective observational study. SettingUniversity teaching hospital general adult intensive care unit. Patients15 consecutive patients admitted to the intensive care unit after refractory Out Hospital Cardiac Arrest due to acute coronary syndrome treated by Extra Corporeal Life Support. InterventionsArterial base excess and lactate concentrations were measured immediately after starting ECLS and every 3h after. ResultsBoth base excess and arterial lactate measured 3h after starting ECLS effectively predict multiorgan failure occurrence and mortality in the following 21h (area under the curve on receiver operating characteristic analysis of 0.97, 0.95 respectively). The best predictive values were obtained with a base excess level measured 3h after starting ECLS of less than −10mmol/l and lactate concentrations greater than 12mmol/l. The combination of these two markers measured 3h after starting ECLS predicted multiorgan failure occurrence and mortality in the following 21h with a sensitivity of 70% and a specificity of 100%. ConclusionsCombination of base excess and lactate, measured 3h after starting ECLS, can be used to predict multiorgan failure occurrence and mortality in the following 21h in patients admitted to an intensive care unit for refractory Out Hospital Cardiac Arrest due to acute coronary syndrome treated by Extra Corporeal Life Support. These parameters can be obtained simply and rapidly and help in the decision process to continue ECLS for refractory CA.