Abstract 74: Sequential Organ Failure Assessment Score at Presentation Predicts Survival in Venoarterial Extracorporeal Membrane Oxygenation

Abstract

Background: Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) has been reported to improve survival in patients with cardiogenic shock (CS) or cardiac arrest (CA). However, overall mortality remains high and many patients may not benefit from ECMO. The Sequential Organ Failure Assessment (SOFA) score is an assessment of a patient’s organ function in the setting of shock composed of scores for the respiratory, cardiovascular, hepatic, coagulation, renal, and neurologic systems, graded 0 to 4 based on level of dysfunction. We investigated the role of the SOFA score in predicting survival in CS and CA patients treated with ECMO. Methods: We performed a retrospective review of all patients treated with percutaneous VA ECMO at the University of Chicago Medical Center from January to December 2012. SOFA score at presentation was calculated using available clinical data. Demographics, clinical characteristics, and outcomes of survivors versus non-survivors were compared using fisher’s exact test. An age adjusted logistic regression model was used to calculate the association between SOFA score and survivor status. Results: Percutaneous VA ECMO was initiated in 15 patients. 7 were alive at 30 days after ECMO initiation. Survivors had a significantly lower baseline median SOFA score (9 vs 16, p= 0.03, OR 0.577 ). The only other significant predictors of survival were female sex and smaller cannula size. Major complications included hemorrhage (2), HIT (1) and DIC (1). Limb ischemia was not seen in any patients as all patients underwent anterograde cannulation at the time of ECMO initiation Conclusions: The presenting SOFA score predicts survival in patients with CS or CA who undergo VA ECMO. Calculation of the SOFA score at presentation may help physicians decide which patients may derive benefit from ECMO.