A retrospective multicenter registry analysis included 662 patients with cardiogenic shock who remained on VA-ECMO for at least 48 hours. Patients with 48-hour lactate below 2.0 mmol/L had more favorable neurologic discharge, defined as Cerebral Performance Category 1–2, than those with persistent elevation (71.4% versus 41.9%). Normalization remained independently associated with favorable neurologic discharge (odds ratio 3.12, 95% confidence interval 2.21–4.41). It was also associated with lower all-cause mortality at 12 months (hazard ratio 0.49, 95% confidence interval 0.38–0.64).
Lactate normalization at 48 hours was associated with better neurologic discharge outcomes and 12-month survival during VA-ECMO. These findings support prognostic relevance, not a causal benefit of targeting lactate normalization.
Study limitation: Retrospective analysis restricted to patients remaining on ECMO for at least 48 hours; baseline severity differences leave potential residual confounding.
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