TY - JOUR
T1 - Risk prediction of in-hospital mortality in patients with venoarterial extracorporeal membrane oxygenation for cardiopulmonary support
T2 - The ECMO-ACCEPTS score
AU - Becher, Peter M.
AU - Twerenbold, Raphael
AU - Schrage, Benedikt
AU - Schmack, Bastian
AU - Sinning, Christoph R.
AU - Fluschnik, Nina
AU - Schwarzl, Michael
AU - Waldeyer, Christoph
AU - Seiffert, Moritz
AU - Clemmensen, Peter
AU - Neumann, Johannes T.
AU - Bernhardt, Alexander M.
AU - Zeymer, Uwe
AU - Thiele, Holger
AU - Reichenspurner, Hermann
AU - Blankenberg, Stefan
AU - Westermann, Dirk
N1 - Copyright © 2019 Elsevier Inc. All rights reserved.
PY - 2020/4
Y1 - 2020/4
N2 - PURPOSE: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an increasingly used treatment option for patients in need of mechanical cardiopulmonary support, while available outcome data is limited. The aim of this study was to identify predictors for 30-day in-hospital mortality.MATERIAL AND METHODS: We analyzed baseline characteristics and outcomes of 8351 VA-ECMO procedures performed in Germany from 2007 to 2015. Using a multivariable model, we identified the ten most important variables to allow for prediction of 30-day in-hospital mortality. Based on these variables, we created a mortality prediction score (ECMO-ACCEPTS score) to enhance decision making in patients considered for or treated with VA-ECMO support.RESULTS: Of 8351 patients (71.7% male) 3567 had prior CPR. Mean age was 62 years in the present cohort. The overall 30-day in-hospital mortality was 61%. The ECMO-ACCEPTS score, derived among randomly selected 4175 patients, included ten independent predictors for in-hospital mortality. Internal validation in the remaining 4176 patients confirmed strong differentiation between low and high risk of 30-day in-hospital mortality (r = 0.97 for correlation of predicted with observed mortality, p < .001).CONCLUSIONS: The ECMO-ACCEPTS score might help clinicians to improve risk prediction among VA-ECMO patients for refractory cardiogenic shock.
AB - PURPOSE: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an increasingly used treatment option for patients in need of mechanical cardiopulmonary support, while available outcome data is limited. The aim of this study was to identify predictors for 30-day in-hospital mortality.MATERIAL AND METHODS: We analyzed baseline characteristics and outcomes of 8351 VA-ECMO procedures performed in Germany from 2007 to 2015. Using a multivariable model, we identified the ten most important variables to allow for prediction of 30-day in-hospital mortality. Based on these variables, we created a mortality prediction score (ECMO-ACCEPTS score) to enhance decision making in patients considered for or treated with VA-ECMO support.RESULTS: Of 8351 patients (71.7% male) 3567 had prior CPR. Mean age was 62 years in the present cohort. The overall 30-day in-hospital mortality was 61%. The ECMO-ACCEPTS score, derived among randomly selected 4175 patients, included ten independent predictors for in-hospital mortality. Internal validation in the remaining 4176 patients confirmed strong differentiation between low and high risk of 30-day in-hospital mortality (r = 0.97 for correlation of predicted with observed mortality, p < .001).CONCLUSIONS: The ECMO-ACCEPTS score might help clinicians to improve risk prediction among VA-ECMO patients for refractory cardiogenic shock.
KW - Cardiogenic shock
KW - Cardiopulmonary support
KW - Risk prediction
KW - Venoarterial extracorporeal membrane oxygenation
UR - http://www.scopus.com/inward/record.url?scp=85077061594&partnerID=8YFLogxK
U2 - 10.1016/j.jcrc.2019.12.013
DO - 10.1016/j.jcrc.2019.12.013
M3 - Article
C2 - 31896442
AN - SCOPUS:85077061594
SN - 0883-9441
VL - 56
SP - 100
EP - 105
JO - Journal of Critical Care
JF - Journal of Critical Care
ER -