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The Utility of Risk Scores in Postcardiotomy Extracorporeal Membrane Oxygenation
Sevinç B Erdoğan1, Murat Bastopcu1, Mehmet Kağan Usca1
1Department of Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Center, Istanbul, Turkey.
Perfusion
|January 27, 2023
Summary
Risk scores for postcardiotomy extracorporeal membrane oxygenation (ECMO) patients are challenging. The VIS score at 24 hours shows promise for predicting survival in these critical cases.
Area of Science:
- Cardiology
- Critical Care Medicine
- Medical Technology
Background:
- Post-cardiotomy shock (PC-ECMO) patients require venoarterial extracorporeal membrane oxygenation (ECMO) for survival.
- Risk stratification for PC-ECMO patients is currently difficult.
- This study evaluates existing risk scores for predicting mortality in PC-ECMO patients.
Purpose of the Study:
- To assess the discriminatory ability of various risk scores in predicting mortality for patients on PC-ECMO.
- To identify reliable risk stratification tools for this high-risk population.
Main Methods:
- Retrospective analysis of 109 patients (aged >18 years) who received ECMO for postcardiotomy shock between January 2017 and June 2022.
- Comparison of the predictive performance of STS, Euroscore II, SAVE, modified SAVE, APACHE II, and VIS scores for weaning and 30-day survival.
- Evaluation of discriminatory ability using Area Under the Curve (AUC).
Main Results:
- The Euroscore II and STS scores did not significantly predict 30-day mortality.
- SAVE, modified SAVE, APACHE II, and VIS scores significantly predicted 30-day mortality.
- VIS (AUC 0.844) and APACHE II (AUC 0.727) demonstrated satisfactory discriminatory ability, while SAVE (AUC 0.672) and modified SAVE (AUC 0.695) showed moderate ability.
Conclusions:
- Existing risk scores offer limited predictive accuracy for PC-ECMO patient outcomes.
- The VIS score, particularly at 24 hours, shows potential as a valuable tool for risk assessment.
- Further research is needed to develop and validate novel risk scoring systems for PC-ECMO.
