Cardiac markers and Blood lactate levels are significant indicators of survival in Extra-Corporeal Membrane Oxygenation (ECMO) after adult cardiac surgery
Presented During:
Friday, September 20, 2024: 5:00PM - 6:30PM
Omni King Edward Hotel
Abstract No:
10127
Submission Type:
Abstract Submission
Authors:
Joon Young Kim (1), Pil-Je Kang (2), Ho Jin Kim (3), Jae Suk Yoo (4), Sung-Ho Jung (5), cheol hyun chung (6), Joon Bum Kim (2)
Institutions:
(1) Asan Medical Center, Seoul, South Korea, (2) Asan Medical Center, Seoul, NA, (3) Asan Medical Center, Seoul, Korea, (4) Asan Medical Center, Bucheon-si, Seoul, (5) Asan Medical Center, Seoul, (6) N/A, Seoul, South Korea
Submitting Author:
*Joon Bum Kim
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Asan Medical Center
Asan Medical Center
Co-Author(s):
Pil-Je Kang
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Asan Medical Center
Asan Medical Center
Ho Jin Kim
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Asan Medical Center
Asan Medical Center
Jae Suk Yoo
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Asan Medical Center
Asan Medical Center
Sung-Ho Jung
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Asan Medical Center
Asan Medical Center
cheol hyun chung
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*Joon Bum Kim
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Asan Medical Center
Asan Medical Center
Presenting Author:
*Joon Bum Kim
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Asan Medical Center
Asan Medical Center
Abstract:
OBJECTIVE: No prognostic indicators of myocardial recovery in patients requiring extra-corporeal membrane oxygenation (ECMO) support after cardiac surgery have been established. We evaluated whether cardiac markers (CK-MB and Troponin-I), indicators of myocardial recovery and blood lactate levels, an indicator of adequate tissue perfusion, can predict survival in patients undergoing ECMO after cardiac surgery.
METHODS: Patients who underwent venoarterial-ECMO (VA-ECMO) support for postcardiotomy cardiogenic shock (PCS) after major cardiac surgery from May 2005 to December 2021 were included. The primary outcome was ECMO weaning failure. The cardiac markers and blood lactate levels serially measured during ECMO (at pre-ECMO, 6, 12, 24, and 48 hours) were analyzed. To facilitate interpretation, optimal cutoff points for cardiac markers and blood lactate levels were determined based on the highest Youden index score, considering both sensitivity and specificity. Logistic regression analyses were conducted to assess whether cardiac markers and blood lactate levels could predict survival.
RESULTS: A total of 300 patients (mean age, 62.9 ± 13.4 years, 133 female patients) constituted the study cohort. 155 patients (51.7%) were successfully weaned from ECMO and 110 patients (36.7%) survived to discharge. Based on the highest Youden index score, the optimal cutoff points for CK-MB and blood lactate levels at 48 hours after ECMO initiation were 85.8 ng/mL (sensitivity 60.3%, specificity 71.7%) and 7.9 mmol/L (sensitivity 80.9%, specificity 91.2%), respectively. The area under the receiver operating characteristic curve (AUROC) for Troponin-I was less than 0.6, indicating that it was not useful as a predictor of weaning ECMO. CK-MB levels at 48 hours above the optimal cutoff point (OR, 4.47; 95% CI, 2.20-9.11) and blood lactate levels at 48 hours above the optimal cutoff point (OR, 15.89; 95% CI, 4.66-54.17) were associated with ECMO weaning failure.
CONCLUSIONS: CK-MB levels and blood lactate levels were significantly lower in survival patients. Each of them at 48 hours after the initiation ECMO can be the predictors of ECMO weaning failure.
METHODS: Patients who underwent venoarterial-ECMO (VA-ECMO) support for postcardiotomy cardiogenic shock (PCS) after major cardiac surgery from May 2005 to December 2021 were included. The primary outcome was ECMO weaning failure. The cardiac markers and blood lactate levels serially measured during ECMO (at pre-ECMO, 6, 12, 24, and 48 hours) were analyzed. To facilitate interpretation, optimal cutoff points for cardiac markers and blood lactate levels were determined based on the highest Youden index score, considering both sensitivity and specificity. Logistic regression analyses were conducted to assess whether cardiac markers and blood lactate levels could predict survival.
RESULTS: A total of 300 patients (mean age, 62.9 ± 13.4 years, 133 female patients) constituted the study cohort. 155 patients (51.7%) were successfully weaned from ECMO and 110 patients (36.7%) survived to discharge. Based on the highest Youden index score, the optimal cutoff points for CK-MB and blood lactate levels at 48 hours after ECMO initiation were 85.8 ng/mL (sensitivity 60.3%, specificity 71.7%) and 7.9 mmol/L (sensitivity 80.9%, specificity 91.2%), respectively. The area under the receiver operating characteristic curve (AUROC) for Troponin-I was less than 0.6, indicating that it was not useful as a predictor of weaning ECMO. CK-MB levels at 48 hours above the optimal cutoff point (OR, 4.47; 95% CI, 2.20-9.11) and blood lactate levels at 48 hours above the optimal cutoff point (OR, 15.89; 95% CI, 4.66-54.17) were associated with ECMO weaning failure.
CONCLUSIONS: CK-MB levels and blood lactate levels were significantly lower in survival patients. Each of them at 48 hours after the initiation ECMO can be the predictors of ECMO weaning failure.
Mechanical Support and Thoracic Transplantation Summit:
ECMO/Mechanical Support
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