Vasoactive-Inotropic Score and Vasoactive-Ventilation-Renal Score as Outcome Predictors for Children on Extracorporeal Membrane Oxygenation.

Ira Shukla,Sheila J Hanson,Ke Yan,Jian Zhang

doi:10.3389/fped.2021.769932

Abstract

We aimed to determine the association of vasoactive-inotropic score (VIS) and vasoactive-ventilation-renal (VVR) score with in-hospital mortality and functional outcomes at discharge of children who receive ECMO. A sub-analysis of the multicenter, prospectively collected data by the Collaborative Pediatric Critical Care Research Network (CPCCRN) for Bleeding and Thrombosis on ECMO (BATE database) was conducted. Of the 514 patients who received ECMO across eight centers from December 2012 to February 2016, 421 were included in the analysis. Patients > 18 years of age, patients placed on ECMO directly from cardiopulmonary bypass or as an exit procedure, or patients with an invalid or missing VIS score were excluded. Higher VIS (OR = 1.008, 95% CI: 1.002–1.014, p = 0.011) and VVR (OR: 1.006, 95% CI: 1.001–1.012, p = 0.023) were associated with increased mortality. VIS was associated with worse Pediatric Cerebral Performance Category (PCPC) (OR = 1.027, 95% CI: 1.010–1.044, p = 0.002) and Pediatric Overall Performance Category (POPC) score (OR = 1.023, 95% CI: 1.009–1.038, p = 0.002) at discharge. No association was found between VIS or VVR and Functional Status Score (FSS) at discharge. Using multivariable analyses, controlling for ECMO mode, ECMO location, ECMO indication, primary diagnosis, and chronic diagnosis, extremely high VIS and VVR were still associated with increased mortality.

Highlights

Extracorporeal membrane oxygenation (ECMO) is increasingly used in pediatric patients with life-threatening cardiac and respiratory disorders [1]
Patients were selected through the de-identified Bleeding and Thrombosis during ECMO (BATE) database released for the public use by the Collaborative Pediatric Critical Care Research Network (CPCCRN) [10]
With analysis of the functional outcomes of Pediatric Cerebral Performance Category (PCPC), Pediatric Overall Performance Category (POPC), and Functional Status Score (FSS) scores by favorable and unfavorable categories (Table 3), VasoactiveInotropic Score (VIS) was significantly associated with unfavorable POPC (OR = 1.023; 95% CI:1.009–1.038, p = 0.0019) and PCPC

Summary

Introduction

Extracorporeal membrane oxygenation (ECMO) is increasingly used in pediatric patients with life-threatening cardiac and respiratory disorders [1]. According to the Extracorporeal Life Support Organization (ELSO) registry, there are two scores established to predict mortality for pediatric patients requiring ECMO for respiratory failure, the Outcome Predictors for ECMO. Pediatric Risk Estimation Score for Children Using Extracorporeal Respiratory Support (PED-RESCUERS) [2] and Pediatric Pulmonary Rescue with Extracorporeal Membrane Oxygenation Prediction Score (P-PREP) [3]. These scores are developed and validated only for patients requiring ECMO for a primary respiratory indication and neither of them looked at functional status as their outcomes. The VasoactiveVentilation-Renal (VVR) Score has been recently developed and subsequently validated in the pediatric post-operative cardiac surgical population to predict mortality [8, 9]

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