To correlate the initial and maximal lactate levels with the occurrence of intracranial hemorrhage (ICH) and survival in patients treated with extracorporeal life support (ECLS).
Retrospective chart review.
Pediatric intensive care unit.
Eighty-two neonatal patients placed on ECLS for respiratory failure due to sepsis, meconium aspiration, or persistent pulmonary hypertension of the newborn.
The initial lactate level measured within 6 hours of initiating ECLS and the maximal lactate level measured throughout the ECLS course were collected. Lactate levels were described as mean lactate +/- SE (mM). Head ultrasound reports and survival were reviewed. Platelet counts and activated clotting times (ACTs) were examined.
The mean initial and maximal lactate levels were higher in ECLS patients who developed ICH (initial: 10 +/- 1.7 mM vs 6.4 +/- 0.8 mM, p = .05 and maximal: 12.4 +/- 2.5 mM vs 7.9 +/- 0.8 mM, p = .04). Initial and maximal lactate levels were also elevated in nonsurvivors (initial: 11.7 +/- 3 mM vs 6.4 +/- 0.7 mM, p = .01 and maximal: 14.8 +/- 3.3 mM vs 7.8 +/- 0.8 mM, P < .01). Platelet counts and ACT did not differ in patients with and without ICH.
Lactate is a useful marker for the development of ICH in ECLS patients. In addition, elevated lactates during ECLS identify a subgroup of patients with poor outcome. Prospective studies are needed to determine whether the incorporation of this information into pre-ECLS and ECLS management will decrease the occurrence of ICH and improve survival.
"In adults the use of ECMO has led to specific complications unique to itself, specifically limb ischemia, oxygenator failure, pumphead thrombus and intracardiac thrombus formation . Intracranial hemorrhage (ICH) is a well recognized complication of neonatal ECMO support with risk factors such as prematurity , cardiac arrest, acidosis, thrombocytopenia, the use of heparin, jugular venous cannulation and carotid artery ligation        . The incidence of ICH in adults on ECMO is not well documented and the risk factors poorly understood or unknown. "
[Show abstract][Hide abstract] ABSTRACT: Intracranial hemorrhage is a recognized complication in neonates and infants on extracorporeal membrane oxygenator support and various risk factors associated with this have been defined. The prevalence and risk factors associated with intracranial hemorrhage in adults on extracorporeal membrane oxygenator support are unknown and this study was performed to define these factors.
A retrospective study of adults supported with extracorporeal membrane oxygenators at a single institution between January 1992 and December 1996 was performed. Age, gender, weight, body surface area, renal function, anticoagulation, coagulation variables, blood flow, arterial pressure, arterial cannulation sites, duration of support, extracranial bleeding, native cardiac function and presence of intracranial microemboli were analyzed to determine the risk factors for intracranial hemorrhage.
Fourteen out of 74 adults on extracorporeal membrane oxygenator support had intracranial hemorrhage (18.9%). An increased risk of intracranial hemorrhage showed a positive correlation with female gender (P = 0.02, odds ratio 6.5), use of heparin (P = 0.05, odds ratio 8.5), creatinine greater than 2.6 mg/ dl (P = 0.009, odds ratio 6.5), need for dialysis (P = 0.03, odds ratio 4.3) and thrombocytopenia (P = 0.007, odds ratio 18.3). Diminishing renal function and the need for dialysis were associated with increasing duration of support. Multivariable logistic regression showed female gender and thrombocytopenia, especially with platelet counts less than 50000 cells/mm3 to be the most important predictors of intracranial hemorrhage. Intracranial hemorrhage was associated with a mortality of 92.3% compared with a mortality of 61% in those without intracranial hemorrhage (P = 0.027).
Intracranial hemorrhage is a significant complication in adults on extracorporeal membrane oxygenator support. Judicious management of anticoagulation, prevention of renal failure and aggressive correction of thrombocytopenia may help to lower the risk of intracranial hemorrhage in adults on extracorporeal membrane oxygenator support.
European Journal of Cardio-Thoracic Surgery 05/1999; 15(4):508-14. DOI:10.1016/S1010-7940(99)00061-5 · 3.30 Impact Factor
"Additional investigation is required to delineate the role cephalad catheters may play in the clinical monitoring, bedside management and long-term outcome of patients on ECMO. The use of cerebral biochemical Markers taken from jugular venous catheters may help to predict neurodevelopmental outcome in this patient population . "
[Show abstract][Hide abstract] ABSTRACT: When used during extracorporeal membrane oxygenation (ECMO), jugular venous bulb catheters, known as cephalad cannulae, increase venous drainage, augment circuit flow and decompress cerebral venous pressure. Optimized cerebral oxygen delivery during ECMO may contribute to a reduction in neurological morbidity. This study describes the use of cephalad cannulae and identifies rudimentary data for jugular venous oxygen saturation (JVO2) and arterial to jugular venous oxygen saturation difference (AVDO2) in this patient population.
Patients on venoarterial (VA) ECMO displayed higher JVO2 (P < 0.01) and lower AVDO2 (P = 0.01) than patients on venovenous (VV) ECMO (P < 0.01). During VV ECMO, JVO2 was higher and AVDO2 lower when systemic pH was < 7.35 rather than > 7.4 (P = 0.01). During VA ECMO, similar differences in AVDO2 but not in JVO2 were observed at different pH levels (P = 0.01).
Jugular venous saturation and AVDO2 were influenced by systemic pH, ECMO type and patient age. These data provide the foundation for normative values of JVO2 and AVDO2 in neonates and children treated with ECMO.
[Show abstract][Hide abstract] ABSTRACT: Base deficit is a non-respiratory indicator of acid base status. Aim of this study is to assess relationship between the base deficit value in immediate post operative period of CABG and valvular heart disease with cardiopulmonary and in hospital outcome of patient. A total of 136 consecutive with CABG and valvular heart disease scheduled in study. 20 variables were determined during the pre-intra-and postoperative period. Statistical univariate analysis was performed differentiating patients whose initial base deficit after weaning from cardiopulmonary bypass was -8 meq and these whose base deficit was equal or more than -8 meq. Secondly a logistic regression model was performed on the variables shown to have a statistically significant difference in univariate analysis with determination of the odd ratio. 3 variables had a statistically significant difference in univariate analysis and 2 of them high lighted by the linear logistic model. The value of base deficit measured during the immediate postoperative open-heart surgery is correlated with volume of fresh frozen plasma and blood transfusion after open heart surgery and using of intra aortic balloon pump after surgery. Acta Medica Iranica 2007; 45(3): 227-232.
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