Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China.
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
Crit Care. 2019 Jan 11;23(1):11. doi: 10.1186/s13054-019-2307-y.
Prediction scoring systems for coronary artery bypass grafting (CABG) patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) have not yet been reported. This study was designed to develop a predictive score for in-hospital mortality for cardiogenic shock patients who received VA-ECMO after isolated CABG.
Retrospective cohort study of consecutive CABG patients supported with VA-ECMO (n = 166) at the Beijing Anzhen Hospital between February 2004 and March 2017.
One hundred and six patients (64%) could be weaned from VA-ECMO, and 74 patients (45%) survived to hospital discharge. On the basis of multivariable logistic regression analyses, the pRedicting mortality in patients undergoing veno-arterial Extracorporeal MEMBrane oxygenation after coronary artEry bypass gRafting (REMEMBER) score was created with six pre-ECMO parameters: older age, left main coronary artery disease, inotropic score > 75, CK-MB > 130 IU/L, serum creatinine > 150 umol/L, and platelet count < 100 × 10/L. Four risk classes, namely class I (REMEMBER score 0-13), class II (14-19), class III (20-25), and class IV (> 25) with their corresponding mortality (13%, 55%, 70%, and 94%, respectively), were identified. The area under the receiver operating characteristic curve 0.85(95% CI 0.79-0.91) for the REMEMBER score was better than those for the SOFA, SAVE, EuroSCORE, and ENCOURAGE scores in this population.
The REMEMBER score might help clinicians at bedside to predict in-hospital mortality for patients receiving VA-ECMO after isolated CABG for refractory cardiogenic shock. Prospective studies are needed to externally validate this scoring system.
在接受静脉-动脉体外膜肺氧合（VA-ECMO）支持的冠状动脉旁路移植术（CABG）患者中，尚未报道预测评分系统。本研究旨在为单独 CABG 后接受 VA-ECMO 支持的心源性休克患者建立预测住院死亡率的预测评分。
回顾性队列研究连续 CABG 患者支持与 VA-ECMO（n = 166）在北京安贞医院在 2004 年 2 月至 2017 年 3 月。
106 例患者（64%）可从 VA-ECMO 中撤机，74 例患者（45%）存活至出院。基于多变量逻辑回归分析，建立了 6 个 ECMO 前参数的预测接受静脉-动脉体外膜肺氧合后患者死亡率的预测死亡率在接受 veno-arterial extracorporeal MEMBrane oxygenation 后接受冠状动脉旁路移植术的患者中（REMEMBER）评分：年龄较大，左主干冠状动脉疾病，正性肌力评分>75，CK-MB>130IU/L，血清肌酐>150μmol/L，血小板计数<100×10/L。确定了四个风险类别，即 I 类（REMEMBER 评分 0-13）、II 类（14-19）、III 类（20-25）和 IV 类（>25），相应的死亡率分别为 13%、55%、70%和 94%。在该人群中，REMEMBER 评分的受试者工作特征曲线下面积为 0.85（95%CI 0.79-0.91），优于 SOFA、SAVE、EuroSCORE 和 ENCOURAGE 评分。
在接受单独 CABG 治疗难治性心源性休克的患者中，REMEMBER 评分可能有助于临床医生床边预测接受 VA-ECMO 治疗后的住院死亡率。需要前瞻性研究来验证该评分系统。
