Prognosis of Hypothermic Patients Undergoing ECLS Rewarming-Do Alterations in Biochemical Parameters Matter?

Hubert Hymczak,Mathieu Pasquier,Dariusz Plicner,Konrad Mendrala,Radosław Gocoł,Sylweriusz Kosiński,Damian Hudziak,Tomasz Darocha,Paweł Podsiadło

doi:10.3390/ijerph18189764

Abstract

Background: While ECLS is a highly invasive procedure, the identification of patients with a potentially good prognosis is of high importance. The aim of this study was to analyse changes in the acid-base balance parameters and lactate kinetics during the early stages of ECLS rewarming to determine predictors of clinical outcome. Methods: This single-centre retrospective study was conducted at the Severe Hypothermia Treatment Centre at John Paul II Hospital in Krakow, Poland. Patients ≥18 years old who had a core temperature (Tc) < 30 °C and were rewarmed with ECLS between December 2013 and August 2018 were included. Acid-base balance parameters were measured at ECLS implantation, at Tc 30 °C, and at 2 and 4 h after Tc 30 °C. The alteration in blood lactate kinetics was calculated as the percent change in serum lactate concentration relative to the baseline. Results: We included 50 patients, of which 36 (72%) were in cardiac arrest. The mean age was 56 ± 15 years old, and the mean Tc was 24.5 ± 12.6 °C. Twenty-one patients (42%) died. Lactate concentrations in the survivors group were significantly lower than in the non-survivors at all time points. In the survivors group, the mean lactate concentration decreased −2.42 ± 4.49 mmol/L from time of ECLS implantation until 4 h after reaching Tc 30 °C, while in the non-survivors’ group (p = 0.024), it increased 1.44 ± 6.41 mmol/L. Conclusions: Our results indicate that high lactate concentration is associated with a poor prognosis for hypothermic patients undergoing ECLS rewarming. A decreased value of lactate kinetics at 4 h after reaching 30 °C is also associated with a poor prognosis.

Highlights

Accidental hypothermia is a specific cause of cardiac arrest (CA) of which a survival rate in witnessed CA is about 56% and is approximately 27% in unwitnessed CA, mostly with good neurologic outcome [1,2]
Extracorporeal life support (ECLS) rewarming is the method of choice in the treatment of out-of-hospital cardiac arrest patients (OHCA) with severe accidental hypothermia [3]
Two patients were excluded from the study because the v-a ECMO was not implanted at the SHTC, and a different treatment regimen was used in conjunction with incomplete medical and laboratory data

Summary

Introduction

Accidental hypothermia is a specific cause of cardiac arrest (CA) of which a survival rate in witnessed CA is about 56% and is approximately 27% in unwitnessed CA, mostly with good neurologic outcome [1,2]. Extracorporeal life support (ECLS) rewarming is the method of choice in the treatment of out-of-hospital cardiac arrest patients (OHCA) with severe accidental hypothermia [3]. While ECLS is a highly invasive procedure, the identification of patients with a potentially good prognosis is of high importance. The aim of this study was to analyse changes in the acid-base balance parameters and lactate kinetics during the early stages of ECLS rewarming to determine predictors of clinical outcome. Patients ≥18 years old who had a core temperature (Tc) < 30 ◦ C and were rewarmed with. The mean lactate concentration decreased −2.42 ± 4.49 mmol/L from time of ECLS implantation until 4 h after reaching Tc 30 ◦ C, while in the non-survivors’

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