Related Experiment Video
Updated: Jun 10, 2025
Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
The Pre-ECPR Score: Developing and Validating a Multivariable Prediction Model for Favorable Neurological Outcomes in
Bengt Redfors1, Anders Byttner2, Daniel Bengtsson3
1Department of Cardiothoracic Anaesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Objectives:
Extracorporeal cardiopulmonary resuscitation (ECPR) can save patients with refractory cardiac arrest; however, according to recent meta-analyses, only 20% of patients achieve favorable outcomes (Modified Rankin Scale 0-3). We aimed to develop and validate an ECPR prediction model to improve patient selection.
Design:
Prognostic model development and internal validation study.
Setting:
Single-center study.
Participants:
All 120 normothermic ECPR patients treated at Sahlgrenska University Hospital between January 2010 and October 2021.
Interventions:
None.
Measurements And Main Results:
Multivariable logistic regression was used to develop the PRognostic Evaluation of ECPR (Pre-ECPR) score. Model performance was assessed through the area under curve (AUC) and compared with the Extracorporeal Life Support Organization (ELSO) "Example of selection criteria for ECPR" for 1-year survival with favorable outcomes. The positive predictive value (PPV) was calculated. Favorable outcomes occurred in 27.5% of the patients. The Pre-ECPR score, incorporating age, no-flow/initial rhythm (a composite variable), total cardiac arrest time, signs of life, pupil dilation, regional cerebral oxygen saturation, arterial pH, and end-tidal CO2, demonstrated an AUC of 0.87 (95% confidence interval [CI] 0.77-0.93). In internal cross-validation, the AUC of 0.79 (95% CI 0.67-0.88) significantly outperformed the ELSO criteria AUC of 0.63 (95% CI 0.54-0.72, p = 0.012). Pre-ECPR score probabilities >6.4% showed 100% sensitivity and a PPV of 40.5% for favorable outcomes.
Conclusions:
The Pre-ECPR score combines multiple weighted predictors to provide a single balanced probability of favorable outcomes in ECPR patient selection. In cross-validation, it demonstrated significantly more favorable discriminatory performance than that of the ELSO criteria.
