A study on the correlation of arterial partial pressure of carbon dioxide and blood lactic acid with gastrointestinal bleeding in patients undergoing extracorporeal membrane oxygenation

ZHU Liangfeng; SHEN Yin; CHEN Wan; LYU Liwen

doi:10.3969/j.issn.1674-3806.2025.02.12

Abstract：Objective To explore the correlation of arterial partial pressure of carbon dioxide and blood lactic acid with gastrointestinal bleeding in patients undergoing extracorporeal membrane oxygenation(ECMO).Methods The clinical data of 94 patients who were admitted to the Emergency Intensive Care Unit of the People's Hospital of Guangxi Zhuang Autonomous Region for treatment of veno-venous extracorporeal membrane oxygenation(VV-ECMO)or venous-arterial extracorporeal membrane oxygenation(VA-ECMO)from January 2020 to December 2022 were retrospectively collected.The patients were divided into bleeding group(21 cases)and non-bleeding group(73 cases)based on whether they experienced gastrointestinal bleeding during the period of ECMO treatment.The clinical data of arterial partial pressure of carbon dioxide and blood lactic acid were compared between the two groups.The risk factors of gastrointestinal bleeding in the patients undergoing ECMO were analyzed by using binary logistic regression.The predictive efficiency of the relevant indicators for gastrointestinal bleeding was analyzed by using receiver operating characteristic(ROC)curves.Results Before the treatment of ECMO,there were no significant differences in vasoactive-inotropic score(VIS),mean arterial pressure(MAP),blood lactic acid and arterial partial pressure of carbon dioxide between the two groups(P＞0.05).After the treatment of ECMO for 24 hours,VIS,blood lactic acid and arterial partial pressure of carbon dioxide in both groups were lower than those before treatment,and the values of MAP in both groups after the treatment of ECMO for 24 hours were higher than those before treatment,and blood lactic acid and arterial partial pressure of carbon dioxide in the non-bleeding group were lower than those in the bleeding group,and the differences were statistically significant(P＜0.05).The results of binary logistic regression analysis showed that arterial partial pressure of carbon dioxide and blood lactic acid 24 hours after the treatment of ECMO were independent risk factors for gastrointestinal bleeding in the patients undergoing ECMO(P＜0.05).The results of ROC curve analysis showed that both arterial partial pressure of carbon dioxide and blood lactic acid 24 hours after the treatment of ECMO could effectively predict the occurrence of gastrointestinal bleeding(P＜0.05),and the combination of the two indicators could further improve the predictive efficiency[AUC(95％CI)=0.752(0.614-0.890),P＜0.05],and the sensitivity and specificity were 71.43％and 79.45％,respectively.Conclusion Arterial partial pressure of carbon dioxide and blood lactic acid after the treatment of ECMO for 24 hours can be used as early predictive indicators of gastrointestinal bleeding during the period of ECMO treatment for the patients,which has important clinical significance in reducing the patients'incidence of gastrointestinal bleeding during the ECMO treatment and improving their survival rate.