Comparison of four intensive care scores in prediction of outcome after Veno-Arterial ECMO: A single-center retrospective study

Objective

Assess the capability of APACHE-II (Acute Physiology and Chronic Health Evaluation II), SOFA (Sequential Organ Failure Assessment scores), Cardiac Surgery Score (CASUS), and SAVE (Survival After VA-ECMO) in predicting outcomes among a cohort of patients undergoing Veno-Arterial ECMO (VA-ECMO).

Design

This is an observational retrospective study of 142 patients who were admitted to the Cardiothoracic Intensive Care Unit (CTICU) after undergoing VA-ECMO insertion.

Setting

CTICU of a tertiary care center.

Participants

All patients admitted to the CTICU for a minimum duration of 24 h, post-VA ECMO insertion, between the years 2015 and 2022.

Interventions

Review of electronic patient records.

Measurements and Results

Scores for APACHE-II, SOFA, and CASUS were calculated 24 h after intensive care units (ICU) admission. The SAVE score was computed from the last available patient details within 24 h of ECMO insertion. Relevant demographic, clinical, and laboratory data for the study was retrieved from electronic patient records. Pre-ECMO serum levels of lactates and creatinine were significantly associated with mortality. Lower ECMO flow rates at 4 h and 12 h post-ECMO cannulation were significantly correlated with survival to discharge. The development of arrhythmias, acute kidney injury (AKI), and the need for continuous renal replacement therapy (CRRT) while on ECMO were significantly associated with mortality. The APACHE-II, SOFA, and CASUS scores, calculated at 24 h of ICU admission, were significantly higher amongst non-survivors. Following risk score categorization using receiver operating characteristic (ROC) curve analysis, it was found that APACHE-II, SOFA, and CASUS scores calculated at 24 h post-ICU admission after ECMO insertion demonstrated moderate predictive ability for mortality, whereas the SAVE score failed to predict mortality. APACHE-II > 27 (AUC of 0.66), calculated 24 h post-ICU admission after ECMO insertion, showed the greatest predictive ability for mortality. Multivariate logistic regression analysis of the four scores showed that APACHE-II > 27 and SOFA > 14, calculated 24 h post-ICU admission after ECMO insertion, were independently significantly predictive of mortality.

Conclusion

The APACHE-II, SOFA, and CASUS, calculated at 24 h of ICU admission, were significantly higher among non-survivors compared to survivors. APACHE-II demonstrated the highest mortality predictive ability. APACHE-II scores of 27 or above, and SOFA scores of 14 or above, at 24 h of ICU admission after ECMO cannulation, can predict mortality and assist physicians in decision-making.

Other Information

Published in: Journal of Cardiothoracic and Vascular Anesthesia
License: http://creativecommons.org/licenses/by/4.0/
See article on publisher's website: https://dx.doi.org/10.1053/j.jvca.2024.10.027