BACKGROUND: The outcome after weaning from postcardiotomy venoarterial extracorporeal membrane oxygenation (VA-ECMO) is poor. In this study, we investigated the prognostic impact of arterial lactate levels at the time of weaning from postcardiotomy VA. METHODS: This analysis included 338 patients from the multicenter PC-ECMO registry with available data on arterial lactate levels at weaning from VA-ECMO. RESULTS: Arterial lactate levels at weaning from VA-ECMO (adjusted OR 1.426, 95%CI 1.157-1.758) was an independent predictor of hospital mortality, and its best cutoff values was 1.6 mmol/L (<1.6 mmol/L, 26.2% vs. ≥ 1.6 mmol/L, 45.0%; adjusted OR 2.489, 95%CI 1.374-4.505). When 261 patients with arterial lactate at VA-ECMO weaning ≤2.0 mmol/L were analyzed, a cutoff of arterial lactate of 1.4 mmol/L for prediction of hospital mortality was identified (<1.4 mmol/L, 24.2% vs. ≥1.4 mmol/L, 38.5%, p = 0.014). Among 87 propensity score-matched pairs, hospital mortality was significantly higher in patients with arterial lactate ≥1.4 mmol/L (39.1% vs. 23.0%, p = 0.029) compared to those with lower arterial lactate. CONCLUSIONS: Increased arterial lactate levels at the time of weaning from postcardiotomy VA-ECMO increases significantly the risk of hospital mortality. Arterial lactate may be useful in guiding optimal timing of VA-ECMO weaning.

Cardiothoracic Department University Hospital of Udine 33100 Udine Italy

Cardiovascular Surgery University Hospital of Duesseldorf 40225 Dusseldorf Germany

Department of Cardiac Surgery Glenfield Hospital University Hospitals of Leicester Leicester LE39QP UK

Department of Cardiac Surgery Sahlgrenska University Hospital 41685 Gothenburg Sweden

Department of Cardiothoracic Surgery Golden Jubilee National Hospital Glasgow G814DY UK

Department of Cardiothoracic Surgery Henri Mondor University Hospital AP HP Paris Est University 94000 Créteil France

Department of Cardiothoracic Surgery Münster University Hospital 48149 Münster Germany

Department of Cardiothoracic Surgery University of Lund 22184 Lund Sweden

Department of Cardiothoracic Transplantation and Vascular Surgery S Orsola Hospital University of Bologna 40138 Bologna Italy

Department of Cardiovascular Surgery Ziekenhuis Oost Limburg 3600 Genk Belgium

Department of Molecular Medicine and Surgery Department of Cardiac Surgery Karolinska Institutet Karolinska University Hospital 171777 Stockholm Sweden

Department of Thoracic and Cardio Vascular Surgery University Hospital Jean Minjoz 25000 Besançon France

Department of Vascular Surgery Nancy University Hospital University of Lorraine 54000 Nancy France

Division of Cardiac Surgery Ospedali Riuniti 34121 Trieste Italy

Division of Cardiothoracic and Vascular Surgery Pontchaillou University Hospital 35000 Rennes France

Division of Cardiothoracic and Vascular Surgery Robert Debré University Hospital 51100 Reims France

Hamburg University Heart Center 20246 Hamburg Germany

Heart and Lung Center Helsinki University Hospital 00290 Helsinki Finland

Heart Center Turku University Hospital and Department of Surgery University of Turku 20521 Turku Finland

Institute of Clinical and Experimental Medicine 14021 Prague Czech Republic

Prince Sultan Cardiac Center Al Hassa 31982 Saudi Arabia

Research Unit of Surgery Anesthesiology and Critical Care University of Oulu 90570 Oulu Finland

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