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Published on: September 15, 2023
Predicting mortality in patients undergoing VA-ECMO after coronary artery bypass grafting: the REMEMBER score
Liangshan Wang1, Feng Yang1, Xiaomeng Wang1
1Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China.
Insights
A new REMEMBER score predicts in-hospital mortality for coronary artery bypass grafting patients on venoarterial extracorporeal membrane oxygenation. This score aids clinicians in managing cardiogenic shock post-CABG.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Medical Informatics
Background:
- No established prediction scoring systems exist for coronary artery bypass grafting (CABG) patients requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO).
- Developing such a score is crucial for managing cardiogenic shock in this high-risk population.
Purpose of the Study:
- To develop and validate a predictive score for in-hospital mortality in patients undergoing VA-ECMO after isolated CABG.
- To identify key pre-ECMO parameters associated with mortality.
Main Methods:
- Retrospective cohort study of 166 CABG patients supported with VA-ECMO.
- Multivariable logistic regression analysis to identify predictors of mortality.
- Development of the REMEMBER score based on identified parameters.
Main Results:
- The REMEMBER score was developed using six pre-ECMO parameters: age, left main coronary artery disease, inotropic score, CK-MB, serum creatinine, and platelet count.
- Four risk classes were defined, showing increasing mortality rates from 13% (Class I) to 94% (Class IV).
- The REMEMBER score demonstrated superior predictive accuracy (AUC 0.85) compared to existing scores (SOFA, SAVE, EuroSCORE, ENCOURAGE).
Conclusions:
- The REMEMBER score can assist clinicians in predicting in-hospital mortality for VA-ECMO patients post-CABG with refractory cardiogenic shock.
- External validation through prospective studies is recommended to confirm the score's utility.
Background:
Prediction scoring systems for coronary artery bypass grafting (CABG) patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) have not yet been reported. This study was designed to develop a predictive score for in-hospital mortality for cardiogenic shock patients who received VA-ECMO after isolated CABG.
Methods:
Retrospective cohort study of consecutive CABG patients supported with VA-ECMO (n = 166) at the Beijing Anzhen Hospital between February 2004 and March 2017.
Results:
One hundred and six patients (64%) could be weaned from VA-ECMO, and 74 patients (45%) survived to hospital discharge. On the basis of multivariable logistic regression analyses, the pRedicting mortality in patients undergoing veno-arterial Extracorporeal MEMBrane oxygenation after coronary artEry bypass gRafting (REMEMBER) score was created with six pre-ECMO parameters: older age, left main coronary artery disease, inotropic score > 75, CK-MB > 130 IU/L, serum creatinine > 150 umol/L, and platelet count < 100 × 109/L. Four risk classes, namely class I (REMEMBER score 0-13), class II (14-19), class III (20-25), and class IV (> 25) with their corresponding mortality (13%, 55%, 70%, and 94%, respectively), were identified. The area under the receiver operating characteristic curve 0.85(95% CI 0.79-0.91) for the REMEMBER score was better than those for the SOFA, SAVE, EuroSCORE, and ENCOURAGE scores in this population.
Conclusions:
The REMEMBER score might help clinicians at bedside to predict in-hospital mortality for patients receiving VA-ECMO after isolated CABG for refractory cardiogenic shock. Prospective studies are needed to externally validate this scoring system.
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