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J Thorac Cardiovasc Surg 2000;119:155-162
© 2000 Mosby, Inc.
CARDIOPULMONARY SUPPORT AND PHYSIOLOGY |
From the Departments of Cardiology and Anesthesia,b Children’s Hospital, Boston, and the Departments of Pediatrics and Anesthesia,a Harvard Medical School, Boston, Mass.
Supported in part by funds from the Nova Biomedical Corporation (Waltham, Mass) and the Boston Children’s Heart Foundation.
Presented at the Forty-eighth Annual Scientific Session of the American College of Cardiology, New Orleans, La, March 7-10, 1999.
Address for reprints: Ricardo Munoz, MD, Cardiac ICU Office, FA-105, Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 (E-mail: munoz_r{at}a1.tch.harvard.edu).
Objective: Our objective was to evaluate the change in lactate level during cardiopulmonary bypass and the possible predictive value in identifying patients at high risk of morbidity and mortality after surgery for congenital cardiac disease.
Methods: We prospectively studied lactate levels in 174 nonconsecutive patients undergoing cardiopulmonary bypass during operations for congenital cardiac disease. Arterial blood samples were taken before cardiopulmonary bypass, during cardiopulmonary bypass (cooling and rewarming), after cardiopulmonary bypass, and during admission to the cardiac intensive care unit. Complicated outcomes were defined as open sternum as a response to cardiopulmonary instability, renal failure, cardiac arrest and resuscitation, extracorporeal membrane oxygenation, and death.
Results: The largest increment in lactate level occurred during cardiopulmonary bypass. Lactate levels decreased between the postbypass period and on admission to the intensive care unit. Patients who had circulatory arrest exhibited higher lactate levels at all time points. Nonsurvivors had higher lactate levels at all time points. A change in lactate level of more than 3 mmol/L during cardiopulmonary bypass had the optimal sensitivity (82%) and specificity (80%) for mortality, although the positive predictive value was low.
Conclusions: Hyperlactatemia occurs during cardiopulmonary bypass in patients undergoing operations for congenital cardiac disease and may be an early indicator for postoperative morbidity and mortality.
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