Erdoğan Sevinç B, Bastopcu Murat, Usca Mehmet Kağan, Çakmak Arif Yasin, Sargın Murat, Aka Serap
Department of Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Center, Istanbul, Turkey.
Perfusion. 2024 Apr;39(3):578-584. doi: 10.1177/02676591231154741. Epub 2023 Jan 27.
The use of a venoarterial extracorporeal membrane oxygenation (ECMO) in the postcardiotomy shock setting (PC-ECMO) can be life-saving. Risk stratification for patients under PC-ECMO is currently challenging. The aim of this study was to assess the discriminatory ability of the different available risk scores for mortality in PC-ECMO patients.
Patients aged >18 years undergoing coronary artery bypass, valve surgery, or a combination of these procedures and implanted an ECMO for postcardiotomy shock between January 2017 and June 2022 in a single ELSO registered center were retrospectively included. The STS, Euroscore II, SAVE, modified SAVE, APACHE II, and VIS scores were compared for their discriminatory ability concerning weaning and 30-day survival.
During the study period, 7342 patients underwent coronary bypass or valve surgery, of whom 109 patients with PC-ECMO were included in the analysis. The Euroscore II and STS scores were not associated significantly with 30-day mortality, whereas the SAVE, the modified SAVE, APACHE II, and VIS scores significantly predicted 30-day mortality. The SAVE and the modified SAVE scores showed moderate discrimination ability with AUCs of 0.672 and 0.695, while the APACHE and VIS scores had a satisfactory discriminatory ability with AUCs of 0.727 and 0.844, respectively.
Currently used risk scores for PC-ECMO patients do not provide satisfactory predictions for weaning and survival. VIS at the 24th hour can be a valuable parameter for risk analysis and prospective studies can investigate novel PC-ECMO risk scoring systems.
在心脏术后休克（PC-ECMO）情况下使用静脉-动脉体外膜肺氧合（ECMO）可挽救生命。目前，对接受PC-ECMO治疗的患者进行风险分层具有挑战性。本研究的目的是评估不同可用风险评分对PC-ECMO患者死亡率的鉴别能力。
回顾性纳入2017年1月至2022年6月在单一ELSO注册中心接受冠状动脉搭桥术、瓣膜手术或两者联合手术且因心脏术后休克植入ECMO的18岁以上患者。比较了胸外科医师协会（STS）、欧洲心脏手术风险评估系统II（Euroscore II）、挽救（SAVE）、改良挽救（modified SAVE）、急性生理与慢性健康状况评分系统II（APACHE II）和血管活性药物评分（VIS）在脱机和30天生存方面的鉴别能力。
在研究期间，7342例患者接受了冠状动脉搭桥术或瓣膜手术，其中109例接受PC-ECMO的患者纳入分析。Euroscore II和STS评分与30天死亡率无显著相关性，而SAVE、改良SAVE、APACHE II和VIS评分显著预测30天死亡率。SAVE和改良SAVE评分显示出中等鉴别能力，曲线下面积（AUC）分别为0.672和0.695，而APACHE和VIS评分具有令人满意的鉴别能力，AUC分别为0.727和0.844。
目前用于PC-ECMO患者的风险评分对脱机和生存的预测并不令人满意。第24小时的VIS可能是风险分析的一个有价值的参数，前瞻性研究可以探索新的PC-ECMO风险评分系统。
