Elevated serum lactate correlates with intracranial hemorrhage in neonates treated with extracorporeal life support.
ABSTRACT 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.
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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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ABSTRACT: BACKGROUND: Neurologic complications in neonates supported with extracorporeal membrane oxygenation (ECMO) are common and diminish their quality of life and survival. An understanding of factors associated with neurologic complications in neonatal ECMO is lacking. The goals of this study were to describe the epidemiology and factors associated with neurologic complications in neonatal ECMO. PATIENTS AND METHODS: Retrospective cohort study of neonates (age ≤30 days) supported with ECMO using data reported to the Extracorporeal Life Support Organization during 2005-2010. RESULTS: Of 7,190 neonates supported with ECMO, 1,412 (20 %) had neurologic complications. Birth weight <3 kg [odds ratio (OR): 1.3; 95 % confidence intervals (CI): 1.1-1.5], gestational age (<34 weeks; OR 1.5, 95 % CI 1.1-2.0 and 34-36 weeks: OR 1.4, 95 % CI 1.1-1.7), need for cardiopulmonary resuscitation prior to ECMO (OR 1.7, 95 % CI 1.5-2.0), pre-ECMO blood pH ≤ 7.11 (OR 1.7, 95 % CI 1.4-2.1), pre-ECMO bicarbonate use (OR 1.3, 95 % CI 1.2-1.5), prior ECMO exposure (OR 2.4, 95 % CI 1.6-2.6), and use of veno-arterial ECMO (OR 1.7, 95 % CI 1.4-2.0) increased neurologic complications. Mortality was higher in patients with neurologic complications compared to those without (62 % vs. 36 %; p < 0.001). CONCLUSIONS: Neurologic complications are common in neonatal ECMO and are associated with increased mortality. Patient factors, pre-ECMO severity of illness, and use of veno-arterial ECMO are associated with increased neurologic complications. Patient selection, early ECMO deployment, and refining ECMO management strategies for vulnerable populations could be targeted as areas for improvement in neonatal ECMO.European Journal of Intensive Care Medicine 06/2013; · 5.17 Impact Factor
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ABSTRACT: Extracorporeal membrane oxygenation (ECMO) is a potentially life-saving treatment for patients in refractory cardiorespiratory failure. Neurological complications that result from ECMO treatment are known to significantly impact patient survival and quality of life. The purpose of this study was to review the incidence of neurological complications of ECMO in the pediatric population and the role of neurosurgery in the treatment of these patients. Data were obtained from the national Extracorporeal Life Support Organization (ELSO) Registry for the years 1990 to 2009. The neurological complications recorded by the registry include CNS hemorrhage, CNS infarction, and seizure. The ECMO Registry at the authors' institution was then searched, and 3 pediatric patients who had undergone craniotomy during ECMO treatment were identified. Children in the ELSO Registry who were treated with ECMO survived to hospital discharge in 65% of cases. Intracranial hemorrhage occurred in 7.4% of the ECMO-treated patients, with 36% of those surviving to hospital discharge. Hemorrhage was more likely in patients younger than 30 days old and in those requiring ECMO for cardiac indications. Cerebral infarction occurred in 5.7% of all ECMO-treated patients. Clinically diagnosed seizures occurred in 8.4% of all ECMO-treated patients. The ECMO Registry at the authors' institution revealed that 1898 patients were treated there. Intracranial hemorrhage was diagnosed in 81 patients (5.8%), and 3 of these patients were treated with craniotomy. Two of the patients were alive with minimal neurological impairment and normal school performance at 10 and 16 years of follow-up. Intracranial hemorrhage is a serious complication of ECMO treatment. While the surgical risk is substantial, there may be a role for surgical evacuation of hemorrhage in well-selected patients.Journal of Neurosurgery Pediatrics 04/2011; 7(4):338-44. · 1.63 Impact Factor