Lactate Generation During Cardiopulmonary Bypass Is Multifactorial And Associated With Poor Outcomes Among Children Undergoing Surgical Correction Of Acyanotic Congenital Defects
Iulia Barbur, BSE, Eric Etchill, MD, Katherine Giuliano, MD, Bret Mettler, MD, Danielle Gottlieb Sen, MD, Jochen Steppan, MD.
Johns Hopkins Hospital, Baltimore, MD, USA.
Objective(s): Hyperlactatemia during cardiopulmonary bypass (CPB) is associated with poor outcomes in adults. We investigated whether CPB hyperlactatemia was associated with worse outcomes among children undergoing correction of acyanotic cardiac defects and identified intra-operative variables associated with hyperlactatemia during CPB.
Methods: We studied 154 children (median age 2 years, IQR [0-8]) with acyanotic defects who underwent cardiac surgery at our institution (2016-2019) with pre-CPB lactates ≤2mmol/L. Demographics, comorbidities, operative variables and STS post-operative complications were compared among patients whose lactate did not increase significantly during CPB (n=101), whose lactate increased during CPB (n=21), and whose lactate increased within 24 hours post-CPB (n=32). We then investigated variables associated with CPB-hyperlactatemia, including nadir oxygen delivery (DO2), area under the DO2 curve (threshold:400mL/min/kg), area under the systolic arterial pressure curve ((SBP) threshold:60-90mmHg per age), and cross-clamp time.
Results: Neither CPB nor post-CPB hyperlactatemia was associated with 30-day mortality. A greater proportion of patients whose lactate increased during CPB experienced re-intubation (24% vs. 3% vs. 7%, p=0.03), post-operative transfusions (33% vs. 28% vs. 11%, p=0.01), and major 30-day complications (62% vs. 56% vs. 38%, p=0.045). The hyperlactatemia ROC curve AUC was 0.88 (Figure 1).
Conclusions: CPB and post-CPB hyperlactatemia was associated with worse post-operative outcomes but not 30-day mortality. The combination of cross-clamp time, oxygen delivery nadir and AUC <400mL/min/kg, and hypotension during CPB were highly associated with hyperlactatemia.
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