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Updated: Oct 9, 2025
Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
Vasoactive-Inotropic Score and Vasoactive-Ventilation-Renal Score as Outcome Predictors for Children on
Ira Shukla1, Sheila J Hanson2, Ke Yan3
1Section of Critical Care, Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, United States.
Insights
Higher vasoactive-inotropic score (VIS) and vasoactive-ventilation-renal (VVR) scores predict increased mortality in pediatric patients on extracorporeal membrane oxygenation (ECMO). These scores also correlate with worse neurological and overall functional outcomes at discharge.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiovascular Research
- Neonatology
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support measure for critically ill children.
- Assessing patient risk and predicting outcomes on ECMO is crucial for clinical decision-making.
- Vasoactive-inotropic score (VIS) and vasoactive-ventilation-renal (VVR) score are proposed metrics for evaluating treatment intensity.
Purpose of the Study:
- To investigate the association between VIS and VVR scores and in-hospital mortality in pediatric ECMO patients.
- To determine the relationship between VIS and VVR scores and functional outcomes at hospital discharge.
- To identify the predictive value of VIS and VVR for mortality and functional status in this population.
Main Methods:
- A sub-analysis of prospectively collected data from the Bleeding and Thrombosis on ECMO (BATE) database.
- Inclusion of 421 pediatric patients who received ECMO across eight centers.
- Exclusion of patients over 18, those on ECMO from cardiopulmonary bypass, or with missing VIS scores.
Main Results:
- Higher VIS and VVR scores were significantly associated with increased in-hospital mortality.
- Elevated VIS was linked to worse Pediatric Cerebral Performance Category (PCPC) and Pediatric Overall Performance Category (POPC) scores at discharge.
- No significant association was found between VIS or VVR and the Functional Status Score (FSS) at discharge.
Conclusions:
- VIS and VVR scores are valuable indicators of mortality risk in pediatric ECMO patients.
- High VIS is associated with poorer neurological and overall functional outcomes post-ECMO.
- These scores can aid in risk stratification and outcome prediction for children undergoing ECMO therapy.
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.
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