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

Hubert Hymczak, Paweł Podsiadło, Sylweriusz Kosiński, Mathieu Pasquier, Konrad Mendrala, Damian Hudziak, Radosław Gocoł, Dariusz Plicner and Tomasz Darocha
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Hubert Hymczak: Department of Anesthesiology and Intensive Care, John Paul II Hospital, 31-202 Krakow, Poland
Paweł Podsiadło: Institute of Medical Sciences, Jan Kochanowski University, 25-369 Kielce, Poland
Sylweriusz Kosiński: Faculty of Health Sciences, Jagiellonian University Medical College, 31-008 Krakow, Poland
Mathieu Pasquier: Emergency Department, Lausanne University Hospital, University of Lausanne, 1015 Lausanne, Switzerland
Konrad Mendrala: Department of Anaesthesiology and Intensive Care, Medical University of Silesia, 40-055 Katowice, Poland
Damian Hudziak: Department of Cardiac Surgery, Medical University of Silesia, 40-055 Katowice, Poland
Radosław Gocoł: Department of Cardiac Surgery, Medical University of Silesia, 40-055 Katowice, Poland
Dariusz Plicner: Unit of Experimental Cardiology and Cardiac Surgery, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland
Tomasz Darocha: Department of Anaesthesiology and Intensive Care, Medical University of Silesia, 40-055 Katowice, Poland

IJERPH, 2021, vol. 18, issue 18, 1-11

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.

Keywords: ECLS; accidental hypothermia; lactate; lactate kinetics; rewarming (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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