Hee Sung Lee1, Hyoung Soo Kim2, Sun Hee Lee2, Song Am Lee3, Jae Joon Hwang3, Jae Bum Park3, Yo Han Kim4, Hyoung Ju Moon4, Woo Surng Lee4. 1. Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hallym University, Hallym University Dongtan Medical Center, Gyeonggi-do, Republic of Korea. 2. Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hallym University, Hallym University Medical Center. Gyeonggi-do, Republic of Korea. 3. Department of Thoracic and Cardiovascular Surgery, School of Medicine, Konkuk University, Konkuk University Seoul Hospital, Seoul, Republic of Korea. 4. Department of Thoracic and Cardiovascular Surgery, School of Medicine, Konkuk University, Konkuk University Chungju Hospital, Chungju-si, Chungbuk, Republic of Korea.
Abstract
BACKGROUND: Prediction of survival and weaning probability in VA ECMO (veno-arterial extracorporeal membrane oxygenation) patients could be of great benefit for real-time decision making on VA ECMO initiation in critical ill patients. We investigated whether the SAPS II score would be a real-time determinant for VA ECMO initiation and could be a predictor of survival and weaning probability in patients on VA ECMO. METHODS: Between January 1, 2010 and December 31, 2014, VA ECMO was carried out on 135 adult patients suffering from primary cardiogenic shock. To avoid selection bias, we excluded respiratory failure patients treated with VV or other types of ECMO. Successful VA ECMO weaning was defined as weaning, followed by stable survival for more than 48 hours. Survival after VA ECMO was defined as successful weaning and treatment of the underlying medical condition, followed by discharge without any further events. RESULTS: A total of 135 patients consisted of 41 women and 94 men, with a mean age of 59.4±16.5 years. Fifty-three patients had successful weaning, and 35 survived and were discharged uneventfully. Compared to the non-survivors, the survivors showed a lower SAPS II (67.77±20.79 vs. 90.29±13.31, P<0.001), a lower SOFA score (12.63±3.49 vs. 15.33±2.28, P<0.001), a lower predicted death rate (71.12±30.51 vs. 94.00±9.36, P<0.001), a higher initial ipH (7.14±0.22 vs. 6.98±0.15, P<0.001), and a lower initial lactate level (7.09±4.93 vs. 12.11±4.84, P<0.001). The average duration of hospital stay in the successful vs. failed weaning groups was 33.43±27.41 vs. 6.35±8.71 days, and the average duration of ICU stay in the successful vs. failed weaning groups was 20.60±16.88 vs. 5.39±5.95 days. By multivariate logistic regression analysis of initial parameters for VA ECMO assistance, the simplified acute physiology score II (SAPS II) (OR =1.1019, P=0.0389), ipH (OR =0.0010, P=0.0452), and hospital stay (OR =0.8140, P=0.001) had an association with in-hospital mortality on VA ECMO. The initial SAPS II score [area under the curve (AUC) =0.821] demonstrated significantly superior prediction of VA ECMO mortality than age (AUC =0.697), SOFA score (AUC =0.701), ipH (AUC =0.551), and the other parameters. By multivariable CoX regression analysis of survival, only the SAPS II score proved to have statistical significance (hazard ratio, 1.0423; 95% CI, 1.0083-1.0775; P=0.01). CONCLUSIONS: Although the precise predictive scoring systems for VA ECMO still remains one of the most difficult challenges to ECMO physicians, the SAPS II score could provide valuable information on prognosis to patient himself, family members and caretakers, and might help physicians increase the survival rate and might avoid a waste of healthcare resources.
BACKGROUND: Prediction of survival and weaning probability in VA ECMO (veno-arterial extracorporeal membrane oxygenation) patients could be of great benefit for real-time decision making on VA ECMO initiation in critical ill patients. We investigated whether the SAPS II score would be a real-time determinant for VA ECMO initiation and could be a predictor of survival and weaning probability in patients on VA ECMO. METHODS: Between January 1, 2010 and December 31, 2014, VA ECMO was carried out on 135 adult patients suffering from primary cardiogenic shock. To avoid selection bias, we excluded respiratory failure patients treated with VV or other types of ECMO. Successful VA ECMO weaning was defined as weaning, followed by stable survival for more than 48 hours. Survival after VA ECMO was defined as successful weaning and treatment of the underlying medical condition, followed by discharge without any further events. RESULTS: A total of 135 patients consisted of 41 women and 94 men, with a mean age of 59.4±16.5 years. Fifty-three patients had successful weaning, and 35 survived and were discharged uneventfully. Compared to the non-survivors, the survivors showed a lower SAPS II (67.77±20.79 vs. 90.29±13.31, P<0.001), a lower SOFA score (12.63±3.49 vs. 15.33±2.28, P<0.001), a lower predicted death rate (71.12±30.51 vs. 94.00±9.36, P<0.001), a higher initial ipH (7.14±0.22 vs. 6.98±0.15, P<0.001), and a lower initial lactate level (7.09±4.93 vs. 12.11±4.84, P<0.001). The average duration of hospital stay in the successful vs. failed weaning groups was 33.43±27.41 vs. 6.35±8.71 days, and the average duration of ICU stay in the successful vs. failed weaning groups was 20.60±16.88 vs. 5.39±5.95 days. By multivariate logistic regression analysis of initial parameters for VA ECMO assistance, the simplified acute physiology score II (SAPS II) (OR =1.1019, P=0.0389), ipH (OR =0.0010, P=0.0452), and hospital stay (OR =0.8140, P=0.001) had an association with in-hospital mortality on VA ECMO. The initial SAPS II score [area under the curve (AUC) =0.821] demonstrated significantly superior prediction of VA ECMO mortality than age (AUC =0.697), SOFA score (AUC =0.701), ipH (AUC =0.551), and the other parameters. By multivariable CoX regression analysis of survival, only the SAPS II score proved to have statistical significance (hazard ratio, 1.0423; 95% CI, 1.0083-1.0775; P=0.01). CONCLUSIONS: Although the precise predictive scoring systems for VA ECMO still remains one of the most difficult challenges to ECMO physicians, the SAPS II score could provide valuable information on prognosis to patient himself, family members and caretakers, and might help physicians increase the survival rate and might avoid a waste of healthcare resources.
Authors: Kollengode Ramanathan; Matthew E Cove; Michael G Caleb; Kristine L K Teoh; Graeme Maclaren Journal: J Cardiothorac Vasc Anesth Date: 2014-10-23 Impact factor: 2.628
Authors: J Belohlávek; V Rohn; J Tosovsky; J Kunstyr; M Semrád; J Horák; M Lips; F Mlejnsky; I Vykydal; M Balík; M Strítesky; V Mrázek; A Klein; A Linhart; J Lindner Journal: J Cardiovasc Surg (Torino) Date: 2011-06 Impact factor: 1.888
Authors: Giles J Peek; Miranda Mugford; Ravindranath Tiruvoipati; Andrew Wilson; Elizabeth Allen; Mariamma M Thalanany; Clare L Hibbert; Ann Truesdale; Felicity Clemens; Nicola Cooper; Richard K Firmin; Diana Elbourne Journal: Lancet Date: 2009-09-15 Impact factor: 79.321
Authors: Jean Roger Le Gall; Anke Neumann; François Hemery; Jean Pierre Bleriot; Jean Pierre Fulgencio; Bernard Garrigues; Christian Gouzes; Eric Lepage; Pierre Moine; Daniel Villers Journal: Crit Care Date: 2005-10-06 Impact factor: 9.097
Authors: Hyoung Soo Kim; Kyoung-Ha Park; Sang Ook Ha; Sun Hee Lee; Hong-Mi Choi; Sung-Ai Kim; Sunghoon Park; Sang Ho Jo; Hyun-Sook Kim; Sang Jin Han; Woo Jung Park Journal: J Thorac Dis Date: 2020-05 Impact factor: 2.895
Authors: Sebastian D Sahli; Alexander Kaserer; Donat R Spahn; Markus J Wilhelm; Julia Braun; Maximilian Halbe; Yuliya Dahlem; Muriel A Spahn; Julian Rössler; Bernard Krüger; Francesco Maisano Journal: J Thorac Dis Date: 2022-06 Impact factor: 3.005