Predicting Survival After VA-ECMO for Refractory Cardiogenic Shock: Validating the SAVE Score

Area of Science:

• Cardiology
• Critical Care Medicine
• Medical Device Technology

Background:

• Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly utilized for cardiogenic shock support.
• Predictive models are crucial for identifying suitable candidates for VA-ECMO due to potential complications.
• The Survival After Veno-Arterial Extracorporeal Membrane Oxygenation (SAVE) score is one such predictive tool.

Purpose of the Study:

• To validate the clinical utility of the SAVE score in a contemporary cohort of adult patients with cardiogenic shock.
• To assess the SAVE score's ability to predict survival to hospital discharge in this population.

Main Methods:

• Retrospective analysis of electronic health records from 120 adult patients with cardiogenic shock on VA-ECMO (2011-2018).
• Calculation of SAVE scores for each patient to predict survival.
• Evaluation of SAVE score calibration (predicted vs. observed survival) and discrimination (area under the receiver operating curve).

Main Results:

• Overall survival to hospital discharge was 45%.
• Survivors exhibited significantly higher mean SAVE scores compared to non-survivors (P = 0.001).
• The SAVE score demonstrated adequate discrimination (c-statistic = 0.77) but limited calibration, with observed survival rates exceeding predicted rates across risk classes II-V.

Conclusions:

• The SAVE score underestimates survival in a contemporary North American cohort of adult patients with cardiogenic shock.
• Inaccurate SAVE score performance may result in the inappropriate denial of VA-ECMO therapy for high-risk patients.
• Further research is necessary to validate alternative predictive models for patients requiring VA-ECMO support.