Abstract 10361: Prognostic Impact of Sequential Organ Failure Assessment Score in Cardiogenic Shock or Cardiac Arrest Patients With Percutaneous Veno-Arterial Extracorporeal Membrane Oxygenation

Abstract

Introduction: Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) has been reported to improve survival in patients with cardiogenic shock or cardiac arrest. However, the prognostic predictors were uncertain. We investigated the association between sequential organ failure assessment (SOFA) score just before implantation and clinical outcome in patients undergoing VA-ECMO due to cardiogenic shock and cardiac arrest. Methods: A cohort of 299 patients who underwent ECMO at our hospital was registered from January 2005 to April 2015. We excluded 72 patients caused by non-cardiogenic event. The remaining 227 patients (58±14 years old, male82%) were divided into 2 groups according to initial sequential organ failure assessment (SOFA) score . High SOFA Group: SOFA score ≥13 points (n=106); Low SOFA Group: SOFA score <13 (n=121). Clinical outcome was all -cause death at 30 days. Results: The 87% of patients received VA-ECMO due to cardiac arrest(81 out-of-hospital cardiac arrest, 116 in-hospital cardiac arrest). In baseline characteristics, Low SOFA group was significantly shorter time from collapse to ECMO (35.1 vs. 40.7 min), higher Hb (13.1 vs. 11.6 g/dl), and lower BUN (18.1 vs. 24.4 mEq/l, all p<0.05) than High SOFA group. Incidence of death at 30days was significantly lower in Low SOFA group than in High SOFA group (Low SOFA vs. High SOFA; 56.2% vs. 76.4%: p= 0.0014) . Kaplan-Meier curve showed Low SOFA group was better outcome compared with High group (p<0.001, log-rank test) (Figure). SOFA score was an independent predictor of mortality after adjustment of multiple cofounders (SOFA Score per increase, OR: 1.18, 95% confidence interval: 1.00-1.39, p=0.047). Positive independent predictors of mortality were age (per increase OR: 1.04, 95% CI: 1.01-1.07, p<0.01) and other factors. Conclusions: Initial high SOFA score just before implantation provides worse clinical outcome in patients with VA-ECMO due to cardiogenic shock and cardiac arrest.