A comparison of existing risk prediction models in patients undergoing venoarterial extracorporeal membrane oxygenation

Berhane Worku,Mario Gaudino,Dimitrios Avgerinos,Kumudha Ramasubbu,Ivancarmine Gambardella,Iosif Gulkarov,Sandi Khin

doi:10.1016/j.hrtlng.2020.03.004

Abstract

BackgroundPatients undergoing consideration for venoarterial extracorporeal membrane oxygenation (VA-ECMO) require an immediate risk profile assessment in the setting of incomplete information. A number of survival prediction models for critically ill patients and patients undergoing elective cardiac surgery or institution of VA-ECMO support have been designed. We assess the ability of these models to predict outcomes in a cohort of patients undergoing institution of VA-ECMO for cardiogenic shock or cardiac arrest. MethodsFifty-one patients undergoing institution of VA-ECMO support were retrospectively analyzed. APACHE II, SOFA, SAPS II, Encourage, SAVE, and ACEF scores were calculated. Their ability to predict outcomes were assessed. ResultsIndications for ECMO support included postcardiotomy shock (25%), ischemic etiologies (39%), and other etiologies (36%). Pre-ECMO arrest occurred in 73% and 41% of patients underwent cannulation during arrest. Survival to discharge was 39%. Three survival prediction model scores were significantly higher in nonsurvivors to discharge than surivors; the Encourage score (25.4 vs 20; p = .04), the APACHE II score (23.6 vs 19.2; p = .05), and the ACEF score (3.1 vs 1.8; p = .03). In ROC analysis, the ACEF score demonstrated the greatest predictive ability with an AUC of 0.7. ConclusionsA variety of survival prediction model scores designed for critically ill ICU and VA-ECMO patients demonstrated modest discriminatory ability in the current cohort of patients. The ACEF score, while not designed to predict survival in critically ill patients, demonstrated the best discriminatory ability. Furthermore, it is the simplest to calculate, an advantage in the emergent setting.

Highlights

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly utilized in the setting of cardiogenic shock to provide hemodyamic and respiratory support to the acutely decompensating patient
Cardiac arrest prior to venoarterial extracorporeal membrane oxygenation (VA-ECMO) occurred in 73% with an average downtime of 30 min, and 41% of patients underwent cannulation during cardiac arrest (ECPR À extracorporeal cardiopulmonary resuscitation)
The Encourage score, APACHE II score, and the ACEF score were significantly associated with survival to discharge, while the SAPS, SOFA and SAVE scores demonstrated no difference between survivors and nonsurvivors

Summary

Introduction

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly utilized in the setting of cardiogenic shock to provide hemodyamic and respiratory support to the acutely decompensating patient. Numerous survival prediction models exist for critically ill patients (APACHE II [acute physiology and chronic health evaluation II], SAPS II [simplified acute physiology II], SOFA [sequential organ failure assessment] scores) as well as for patients undergoing elective cardiac surgery (ACEF [age, creatine, ejection fraction] score). These scores have demonstrated variable results in patients undergoing institution of VA-ECMO support.[5,6,7,8,9]. We assess the ability of these models to predict outcomes in a cohort of patients undergoing institution of VA-ECMO for cardiogenic shock or cardiac arrest. It is the simplest to calculate, an advantage in the emergent setting

Methods

Results

Discussion

Conclusion