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Cardiac markers and Blood lactate levels are significant indicators of survival in Extra-Corporeal Membrane Oxygenation (ECMO) after adult cardiac surgery

*Joon Bum Kim Abstract Presenter
Asan Medical Center
Seoul, NA 
South Korea  - Contact Me

Dr. Joon Bum Kim, MD, PhD, is a Professor in Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. He received his medical degree from Yonsei University College of Medicine (2001), completed his Cardiothoracic residency (2006) and Adult Cardiovascular Fellowship (2011) in Asan Medical Center, and joined as a formal faculty member at Asan Medical Center in 2011. He is an awardee of Evert A. Graham Memorial Traveling Fellowship of the American Association for Thoracic Surgery (AATS) in 2014, and spent the fellowship year at Massachusetts General Hospital MGH, Cleveland Clinic and Hermann Memorial Hospital at Houston. His major areas of clinical practices are valve-sparing root surgery, arch reconstruction, thoracoabdominal aorta repair, minimally invasive-valve surgery, minimally invasive open aortic repair, rapid-deployment aortic valve replacement and surgical ablation of atrial fibrillation. Dr. Kim has contributed on several book chapters, has published over 270 papers in peer-reviewed journals.

Membership

     Korean Society of Thoracic & Cardiovascular Surgery (since 2003)

     European Association for Cardio-Thoracic Surgery (since 2011)

     American Heart Association (since 2012)

     Asian Society for Cardiovascular and Thoracic Surgery (since 2015)

     American Association for Thoracic Surgery (since 2017)

     Society  of Thoracic Surgeons (since 2023: International Education Committee Member)

Editorial Board

            Journal of Korean Medical Science (since 2015)

            Journal of Thoracic and Cardiovascular Surgery (since 2018)

            Journal of Thoracic Disease (since 2019)

            Journal of Chest Surgery (since 2019; Associate Editor)

            Asian Cardiovascular and Thoracic Annals (since 2020)

            JACC Asia (since 2021; Section Editor of CV Surgery)

            Korean Circulation Journal (since 2022)

 

Friday, September 20, 2024: 5:00 PM - 6:30 PM
Omni King Edward Hotel 

Description

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.

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