Sandrio Stany, Krebs Joerg, Leonardy Eva, Thiel Manfred, Schoettler Jochen J
Department of Anesthesiology and Critical Care Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68165 Mannheim, Germany.
J Clin Med. 2022 Apr 24;11(9):2390. doi: 10.3390/jcm11092390.
The vasoactive inotropic score (VIS) is calculated as a weighted sum of all administered vasopressor and inotropic medications and quantifies the amount of pharmacological cardiovascular support in patients with the most severe combined cardiopulmonary failure supported with extracorporeal membrane oxygenation (ECMO). This study evaluated (1) whether VIS prior to the initiation of ECMO is an independent predictor of survival in these patients and (2) whether VIS might guide the selection of the appropriate extracorporeal cannulation modality (Veno-Venous 'V-V' or Veno-VenoArterial 'V-VA'). In this study, 39 V-VA and 182 V-V ECMO runs were retrospectively analyzed. VIS immediately prior to ECMO initiation (pre-ECMO) was 40 (10/113) in all patients, 30 (10/80) in patients with V-V ECMO and 207 (60/328) in patients with V-VA ECMO. Pre-ECMO VIS was an independent predictor of survival in univariate (AUC = 0.68, = 0.001) and multi-variable analyses ( = 0.02). Pre-ECMO VIS was clearly associated with mortality ( = 0.001) in V-V ECMO group; however, V-VA ECMO disrupted this association ( = 0.18). Therefore, in conjunction with echocardiography, VIS might assist in selecting the appropriate ECMO cannulation strategy as patients with a pre-ECMO VIS ≥ 61.4 had significantly lower odds of survival compared to those with lower VIS.
血管活性肌力评分（VIS）通过对所有使用的血管加压药和正性肌力药进行加权求和来计算，用于量化接受体外膜肺氧合（ECMO）支持的最严重心肺联合衰竭患者的药理心血管支持量。本研究评估了：（1）启动ECMO前的VIS是否是这些患者生存的独立预测指标；（2）VIS是否可指导选择合适的体外插管方式（静脉-静脉‘V-V’或静脉-动脉-静脉‘V-VA’）。本研究回顾性分析了39例V-VA和182例V-V的ECMO运行情况。所有患者在ECMO启动前（ECMO前）的VIS为40（10/113），V-V ECMO患者为30（10/80），V-VA ECMO患者为207（60/328）。ECMO前VIS在单变量分析（AUC = 0.68，P = 0.001）和多变量分析中（P = 0.02）是生存的独立预测指标。在V-V ECMO组中，ECMO前VIS与死亡率明显相关（P = 0.001）；然而，V-VA ECMO破坏了这种相关性（P = 0.18）。因此，结合超声心动图，VIS可能有助于选择合适的ECMO插管策略，因为与VIS较低的患者相比，ECMO前VIS≥61.4的患者生存几率显著降低。
