Vasoactive Inotropic Score as a Prognostic Factor during (Cardio-) Respiratory ECMO

Area of Science:

• Cardiology
• Critical Care Medicine
• Medical Technology

Background:

• The vasoactive inotropic score (VIS) quantifies cardiovascular support in severe cardiopulmonary failure patients on extracorporeal membrane oxygenation (ECMO).
• Accurate prediction of survival and guidance for ECMO modality selection are critical in these high-risk patients.

Purpose of the Study:

• To determine if pre-extracorporeal membrane oxygenation (ECMO) vasoactive inotropic score (VIS) independently predicts survival.
• To assess if pre-ECMO VIS can guide the choice between Veno-Venous (V-V) and Veno-VenoArterial (V-VA) ECMO cannulation strategies.

Main Methods:

• Retrospective analysis of 39 V-VA and 182 V-V ECMO runs.
• Evaluation of pre-ECMO vasoactive inotropic score (VIS) as a predictor of survival using univariate and multi-variable analyses.
• Assessment of the association between pre-ECMO VIS and mortality within V-V and V-VA ECMO groups.

Main Results:

• Pre-ECMO VIS was an independent predictor of survival (AUC = 0.68, p = 0.001).
• A significant association between pre-ECMO VIS and mortality was observed in the V-V ECMO group (p = 0.001), but not in the V-VA ECMO group (p = 0.18).
• Patients with pre-ECMO VIS ≥ 61.4 had significantly lower survival odds compared to those with lower VIS.

Conclusions:

• Pre-ECMO vasoactive inotropic score (VIS) is a valuable independent predictor of survival in patients requiring extracorporeal membrane oxygenation (ECMO).
• VIS, particularly in conjunction with echocardiography, may assist in selecting the appropriate ECMO cannulation strategy (V-V vs. V-VA).
• A high pre-ECMO VIS threshold (≥ 61.4) identifies patients with substantially reduced survival probability.