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Ann Thorac Surg 2002;73:1027
© 2002 The Society of Thoracic Surgeons

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Correspondence

Preoperative IABP in high-risk patients reduces postoperative lactate release and subsequent mortality: Reply

^a Intensive Care Unit (Austin Campus), Austin and Repatriation Medical Centre, Studley Rd, Heidelberg, Victoria 3084, Australia

e-mail: rb{at}austin.unimelb.edu.au

To the Editor

We appreciate the comments by Drs Christenson and Cohen. However, we believe we might have been misunderstood. We agree entirely with the correspondents that intraaortic balloon pump (IABP) and inotropic drugs are often needed to support the heart after surgery and do not intend to imply that IABP induces an increase in lactate production. Indeed, we strongly advocate the use of IABP under circumstances of low cardiac output. The aim of our article was not to link IABP and lactate production but to find a simple, early, clinically available way of detecting patients who are so sick that, despite inotropic support and IABP, they will go on to die [1]. If patients whose expected mortality, despite IABP support, is still close to 100% can be indentified early, then more advanced extracorporeal life support (ECMO or VADs) can be applied rather than persisting with a strategy which is insufficient to meet the patient’s physiological needs [2].

The presence of a high lactate (greater than 10 mmol/L) in the first few hours of postoperative support in patients already on IABP is a useful marker of patients who need more advanced support. Thus, we strongly support the use of IABP in selected patients but also stand by our conclusion that in a postoperative patient who is already on inotropic support and IABP, the development of a lactate greater than 10 mmol/L should trigger strong consideration of more advanced mechanical cardiovascular support.

References

1. Davies A.R., Bellomo R., Raman J.S., Gutteridge G.A., Buxton B.F. High lactate predicts the failure of intraaortic balloon pumping after cardiac surgery. Ann Thorac Surg 2001;71:1415-1420.
2. Smith C., Bellomo R., Raman J., et al. An extracorporeal membrane oxygenation-based approach to cardiogenic shock in an older population. Ann Thorac Surg 2001;71:1421-1427.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Jai Raman Brian Buxton Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Davies, A. Articles by Buxton, B. Search for Related Content PubMed PubMed Citation Articles by Davies, A. Articles by Buxton, B. Related Collections Mechanical Circulatory Assistance Related Articles