3.1 Metabolic acidosis
Studies have shown that hyper-lactic acidosis is an effective biomarker,
and the severity of pre-ECMO arterial acidosis is related to outcomes[9]. In our study, 5 patients with lactic
acid<10 mmol/L before ECMO were discharged, while in 18
neonates with lactic acid>10mmol/L, only 7 survived. This
suggests that higher lactate levels before ECMO is an independent risk
factor for poor outcomes. There was a significant difference in the
highest lactate, the levels of ECMO 12h and 24h, the lactate clearance
time between two groups (P =0.03, 0.005, 0.001, 0.036, respectively).
The results are similar to those findings of the reports[10,11]. The Fux[12] team
analyzed VA-ECMO patients and found that ischemic heart disease and
arterial lactate were independent predictors of 90-day mortality; The
90-day survival rate of lactic acid>10 mmol/L was lower
than patients with lactic acid<10 mmol/L before ECMO (13% and
55%, P <0.001). If the lactate remained at 3mmol/L after 48h,
the 30-day mortality rate is 52%. Other papers[13,14] suggested that persistent metabolic
acidosis after ECMO reflect the severity of ischemia and hypoxia and
confirmed that the peak lactate level affects the survival rate.
Therefore, early application to reverse poor perfusion and prevention
high lactate are critical factors for successful outcomes following
ECMO.