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Published on: January 17, 2025
The impact of vasoactive inotropic score values on mortality and ECMO-related complications in children
Murat Koç1, Sercan Tak2, Vehbi Doğan3
1Department of Cardiovascular Surgery, University of Health Sciences Türkiye, Ankara Etlik City Hospital, Ankara, Türkiye.
Insights
A vasoactive inotropic score (VIS) of 28 or higher at extracorporeal membrane oxygenation (ECMO) initiation strongly predicts mortality in pediatric patients. Renal complications also significantly worsen outcomes for these critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiovascular Support
- Extracorporeal Life Support
Background:
- Extracorporeal membrane oxygenation (ECMO) is a vital but high-risk therapy, especially for neonates and postcardiotomy patients.
- The vasoactive inotropic score (VIS) is a measure of cardiovascular support with potential prognostic value, but its utility in ECMO patients is not well-established.
- This study investigates the relationship between VIS and outcomes in pediatric patients undergoing ECMO for cardiopulmonary failure.
Purpose of the Study:
- To evaluate the impact of vasoactive inotropic score (VIS) values on mortality in pediatric patients receiving ECMO.
- To assess the association between VIS and ECMO-related complications.
- To determine the prognostic significance of VIS and specific complications for ECMO outcomes.
Main Methods:
- A retrospective analysis of 106 pediatric patients who underwent ECMO from January 2011 to January 2021.
- Data collected included demographics, ECMO indications, cannulation strategies, VIS at initiation, complications, and outcomes.
- Prognostic utility was assessed using ROC curve analysis and multivariate logistic regression, with in-hospital mortality as the primary endpoint.
Main Results:
- In-hospital mortality was 57.5%, with higher rates in neonates (78.6%) and infants (62.0%).
- A VIS score ≥28 at ECMO initiation was independently associated with increased mortality (median VIS: 28 vs. 20; p<0.001), demonstrating strong predictive ability (AUC: 0.815).
- Renal complications requiring dialysis (OR: 3.40; p<0.001) and neurological complications (OR: 2.01; p=0.027) were significant predictors of mortality.
Conclusions:
- A VIS score of 28 or greater at ECMO initiation is a strong predictor of in-hospital mortality in pediatric patients.
- Renal complications requiring dialysis are a critical factor worsening clinical outcomes.
- Integrating VIS into risk stratification and implementing strategies to mitigate complications may improve ECMO patient prognosis.
Background:
Extracorporeal membrane oxygenation (ECMO) provides life-saving support but carries considerable risks, particularly in neonates and postcardiotomy patients. The vasoactive inotropic score (VIS), which measures cardiovascular support, shows potential as a prognostic marker; however, its role in ECMO remains underexplored. This study aims to assess the impact of vasoactive inotropic score values on mortality and ECMO-related complications in patients undergoing ECMO due to cardiopulmonary failure.
Methods:
We analyzed 106 pediatric patients who underwent ECMO between January 2011 and January 2021. The demographics, ECMO indications, cannulation strategies, VIS at initiation, complications, and outcomes were reviewed. The primary endpoint was in-hospital mortality. ROC curve analysis and multivariate logistic regression evaluated the prognostic utility of VIS and ECMO-related complications.
Results:
The in-hospital mortality rate was 57.5%, which was higher among neonates (78.6%), infants (62.0%), and patients who underwent central VA ECMO. VIS at cannulation was independently associated with mortality in multivariate analysis (median VIS: 28 in non-survivors vs. 20 in survivors; p<0.001). A VIS value ≥28 demonstrated strong predictive ability for mortality (area under the curve: 0.815; sensitivity: 82%, specificity: 78%). ECMO-related complications occurred in 62.3% of patients, with renal complications requiring dialysis emerging as the strongest mortality predictor (odds ratio [OR]: 3.40; p<0.001), followed by neurological complications (OR: 2.01; p=0.027).
Conclusion:
A VIS score ≥28 at ECMO initiation strongly predicted in-hospital mortality. Renal complications substantially worsen clinical outcomes. Incorporating VIS into risk stratification protocols and implementing strategies to prevent major complications may improve prognosis of pediatric patients on ECMO.
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