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J Surg Res. 2015 Oct;198(2):273-9. doi: 10.1016/j.jss.2015.04.044. Epub 2015 Apr 22.

Simple new risk score model for adult cardiac extracorporeal membrane oxygenation: simple cardiac ECMO score.

Author information

1
Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
2
Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania.
3
Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania. Electronic address: genex@nifty.com.

Abstract

BACKGROUND:

Although the use of cardiac extracorporeal membrane oxygenation (ECMO) is increasing in adult patients, the field lacks understanding of associated risk factors. While standard intensive care unit risk scores such as SAPS II (simplified acute physiology score II), SOFA (sequential organ failure assessment), and APACHE II (acute physiology and chronic health evaluation II), or disease-specific scores such as MELD (model for end-stage liver disease) and RIFLE (kidney risk, injury, failure, loss of function, ESRD) exist, they may not apply to adult cardiac ECMO patients as their risk factors differ from variables used in these scores.

METHODS:

Between 2010 and 2014, 73 ECMOs were performed for cardiac support at our institution. Patient demographics and survival were retrospectively analyzed. A new easily calculated score for predicting ECMO mortality was created using identified risk factors from univariate and multivariate analyses, and model discrimination was compared with other scoring systems.

RESULTS:

Cardiac ECMO was performed on 73 patients (47 males and 26 females) with a mean age of 48 ± 14 y. Sixty-four percent of patients (47/73) survived ECMO support. Pre-ECMO SAPS II, SOFA, APACHE II, MELD, RIFLE, PRESERVE, and ECMOnet scores, were not correlated with survival. Univariate analysis of pre-ECMO risk factors demonstrated that increased lactate, renal dysfunction, and postcardiotomy cardiogenic shock were risk factors for death. Applying these data into a new simplified cardiac ECMO score (minimal risk = 0, maximal = 5) predicted patient survival. Survivors had a lower risk score (1.8 ± 1.2) versus the nonsurvivors (3.0 ± 0.99), P < 0.0001.

CONCLUSIONS:

Common intensive care unit or disease-specific risk scores calculated for cardiac ECMO patients did not correlate with ECMO survival, whereas a new simplified cardiac ECMO score provides survival predictability.

KEYWORDS:

Cardiogenic shock; ECMO; Risk factors; Survival

PMID:
25990694
DOI:
10.1016/j.jss.2015.04.044
[Indexed for MEDLINE]

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