Comparison of the predictive ability of lactate and central venous blood gas in pediatric venoarterial mode extracorporeal membrane oxygenation outcome.

Abstract

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). This was a retrospective observational study conducted on patients undergoing V-A ECMO care in the pediatric intensive care unit 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. This study consisted of 47 children who received V-A 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 Z 0.001), and 12-24 h (29.4±26.9 mg/dL vs. 69.1±59.1 mg/dL, p = 0.003) after ECMO initiation; however, the central venous blood gas including pH, HCO3, CO2, base excess (BE), and O2 saturation 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), and 12-24h (20.7±10.2 mg/dL vs. 61.9±53.5 mg/dL, p = 0.002); 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) with the best cut-off value of 48.6 mg/dL (sensitivity 48%, specificity 100%). Lactate has better outcome prediction than central venous blood gas in pediatric V-A ECMO. The lactate value 12-24 h after ECMO initiation was an independent factor for unfavorable outcomes.