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Mortality prediction in pediatric postcardiotomy veno-arterial extracorporeal membrane oxygenation: A comparison of
Yu Jin1, Peng Gao1, Peiyao Zhang1
1Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
The Postcannulation Pedi-SAVE score best predicts mortality in pediatric postcardiotomy VA-ECMO patients. Lactate levels and infections are key risk factors for in-hospital mortality in these critically ill children.
Area of Science:
- Pediatric Cardiology
- Extracorporeal Membrane Oxygenation
- Critical Care Medicine
Background:
- Pediatric patients undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) after cardiac surgery face high mortality and morbidity.
- Existing scoring systems (PEP model, Pedi-SAVE) aid risk stratification but require comparative validation.
- Limited research exists on the comparative accuracy of these predictive models in pediatric VA-ECMO populations.
Purpose of the Study:
- To evaluate the predictive performance of the PEP model, Precannulation Pedi-SAVE, and Postcannulation Pedi-SAVE scores.
- To identify independent predictors of in-hospital mortality in pediatric postcardiotomy VA-ECMO patients.
- To compare the efficacy of different scoring systems in risk stratifying this vulnerable patient group.
Main Methods:
- Retrospective analysis of 101 pediatric patients who received VA-ECMO post-cardiac surgery.
- Calculation and comparison of PEP model, Precannulation Pedi-SAVE, and Postcannulation Pedi-SAVE scores.
- Identification of in-hospital mortality risk factors using logistic regression analysis.
Main Results:
- The Postcannulation Pedi-SAVE score demonstrated the highest predictive accuracy (AUROC = 0.816).
- The pre-ECMO PEP model also showed significant predictive value (AUROC = 0.691), while Precannulation Pedi-SAVE had the lowest (AUROC = 0.582).
- Elevated lactate levels at ECMO implantation (OR = 1.199) and infectious complications (OR = 5.169) were independent predictors of in-hospital mortality.
Conclusions:
- Pediatric cardiac ECMO scoring systems are valuable tools for predicting outcomes.
- Both the pre-ECMO PEP model and the Postcannulation Pedi-SAVE score exhibit high predictive value for in-hospital mortality.
- Lactate levels and infectious complications are critical factors influencing survival in pediatric postcardiotomy VA-ECMO.
Background:
Pediatric postcardiotomy veno-arterial extracorporeal membrane oxygenation (VA-ECMO) patients have high mortality and morbidity. There are currently three scoring systems available to predict mortality: the Pediatric Extracorporeal Membrane Oxygenation Prediction (PEP) model, Precannulation Pediatric Survival After VA-ECMO (Pedi-SAVE) score, and Postcannulation Pedi-SAVE score. These methods provide risk stratification scores for pediatric patients requiring ECMO for cardiac support. However, comparative validation of these scoring systems remains scarce. We aim to assess the ability of these models to predict outcomes in a cohort of pediatric patients undergoing VA-ECMO after cardiac surgery, and identify predictors of in-hospital mortality.
Methods:
A retrospective analysis of 101 children admitted to Fuwai Hospital who received VA-ECMO from January 1, 2010 to December 31, 2020 was performed. Patients were divided into two groups, survivors (n = 49) and non-survivors (n = 52) according to in-hospital mortality. PEP model and Pedi-SAVE scores were calculated. The primary outcomes were the risk factors of in-hospital mortality, and the ability of the PEP model, Precannulation Pedi-SAVE and Postcannulation Pedi-SAVE scores to predict in-hospital mortality.
Results:
Postcannulation Pedi-SAVE score accessing the entire ECMO process had the greatest area under receiver operator curve (AUROC), 0.816 [95% confidence interval (CI): 0.733-0.899]. Pre-ECMO PEP model could predict in-hospital mortality [AUROC = 0.691 (95% CI: 0.565-0.817)], and Precannulation Pedi-SAVE score had the poorest prediction [AUROC = 0.582(95% CI: 0.471-0.694)]. Lactate value at ECMO implantation [OR = 1.199 (1.064-1.351), P = 0.003] and infectious complications [OR = 5.169 (1.652-16.172), P = 0.005] were independent risk factors for in-hospital mortality.
Conclusion:
Pediatric cardiac ECMO scoring systems, including multiple risk factors before and during ECMO, were found to be useful in this cohort. Both the pre-ECMO PEP model and the Postcannulation Pedi-SAVE score were found to have high predictive value for in-hospital mortality in pediatric postcardiotomy VA-ECMO.
