100.76 Assessing Mortality Risk in Cardiogenic Shock Patients on VA-ECMO: The Role of SAVE Score, SOFA Score, and 8-Hour Lactate Clearance

Document Type

Conference Proceeding

Publication Date

2-1-2024

Publication Title

JACC Cardiovasc Interv

Abstract

Background: Cardiogenic shock (CS) is a life-threatening perfusion impairment due to cardiac dysfunction. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can provide robust hemodynamic support in patients unresponsive to medical therapy. However, predicting outcomes in patients requiring ECMO support has proved challenging. This study sought to examine in-hospital mortality rates in patients with refractory CS undergoing VA-ECMO and evaluate the association of Survival After VA-ECMO (SAVE) score, Sequential Organ Failure Assessment (SOFA) score, and post-cannulation lactate levels with inpatient mortality. Methods: A retrospective review of adult patients who underwent peripheral VA-ECMO cannulation from January 2018 to September 2022 at a quaternary care center. In-hospital mortality was assessed and compared to predicted mortality by SAVE and SOFA scores, with adjusted odds ratio of risk factors for mortality identified by multivariate logistic regression analysis. Additionally, the prognostic value of 8-hour post-cannulation serum lactate levels was analyzed by receiver operating characteristic (ROC) curve and Kaplan Meier analysis of 30-day survival. Results: 244 patients were included in final analysis. In-hospital mortality was 70%, and 54% of patients died while on ECMO or within 24 hours of decannulation. SAVE score (OR 0.93 per unit increase, 95% CI 0.86 - 0.99, p=0.008), SOFA score (OR 1.53 per unit increase, 95% CI 1.32 - 1.75), and 8-hour post-cannulation lactate level (OR 1.20 per mmol/L increase, 95% CI 1.04 - 1.36, p=0.012) and clearance (OR 0.98 per % decrease, 95% CI 0.97 - 0.99, p=0.026) were independently associated with in-hospital mortality. An 8-hour post-cannulation lactate level above 7.8 mmol/L was associated with high specificity for in-hospital mortality (91.1%). Patients with 8-hour post-cannulation lactate levels above the cutoff of 7.3 mmol/L demonstrated significantly higher 30-day mortality across the entire follow-up period. Conclusion: SAVE and SOFA scores are useful tools in determining prognosis of patients with CS on VA-ECMO. 8-hour post-cannulation serum lactate levels are a pragmatic biomarker which can further assist in prognostication of patients requiring VA-ECMO, and the cutoff of 7.3 mmol/L at 8-hours appears to be a reliable measure. The development of accurate prognostic tools is critical in managing and optimizing care for patients with CS.

Volume

17

Issue

4

First Page

S23

Last Page

S24

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