Klotz et al developed a score for evaluating a patient prior to placement of a ventricular assist device (VAD). These can help to determine the patient's chances of surviving the procedure. The authors are from University Hospital Muenster and Columbia University in New York.
Parameters:
(1) transfusion
(2) inotropic support
(3) blood lactate
(4) heart tests
(5) infection tests
(6) re-sternotomy
(7) mechanical support (ECMO or extra-corporeal membrane oxygenation, IABP or intra-aortic balloon pump, recent cardiac surgery)
(8) ventilation
(9) renal impairment
(10) emergency implant
(11) pre-operative CPR
(12) ischemic cardiomyopathy (ICM)
(13) heart rate
(14) platelet count
(15) blood tests
(16) age in years
|
Parameter |
Finding |
Points |
|
transfusion |
> 10 units pRBCs and/or > 10 units FFP pre-op |
6 |
|
|
none |
0 |
|
inotropic support |
therapy with epinephrine, norepinephrine and/or dobutamine |
5 |
|
|
none |
0 |
|
blood lactate |
> 3 mg/dL |
5 |
|
|
<= 3 mg/dL |
0 |
|
heart lab |
LDH > 500 IU/L and/or CK > 200 U/L and/or troponin I > 20 ng/mL |
5 |
|
|
none |
0 |
|
infectious lab |
CRP > 8 mg/dL AND/OR WBC > 13,000 per µL |
4 |
|
|
none |
0 |
|
re-sternotomy |
yes |
4 |
|
|
no |
0 |
|
mechanical support |
ECMO and/or IABP and/or cardiac surgery within past week |
4 |
|
|
none |
0 |
|
ventilation |
yes |
3 |
|
|
no |
0 |
|
renal impairment |
serum creatinine > 1.5 mg/dL OR BUN > 40 mg/dL OR mechanical renal support including dialysis |
3 |
|
|
none |
0 |
|
emergency implant |
emergency implant OR implant post-cardiotomy |
3 |
|
|
none |
0 |
|
pre-operative CPR |
yes |
2 |
|
|
no |
0 |
|
ICM |
yes |
2 |
|
|
no |
0 |
|
heart rate |
> 100 beats per minute |
1 |
|
|
<= 100 beats per minute |
0 |
|
platelet count |
< 100,000 per µL |
1 |
|
|
>= 100,000 per µL |
0 |
|
blood tests |
hemoglobin < 12 g/dL OR hematocrit < 35% |
1 |
|
|
none |
0 |
|
age in years |
> 50 years |
1 |
|
|
<= 50 years |
0 |
total score =
= SUM(points for all 16 parameters)
Interpretation:
• minimum score: 0
• maximum score: 50
• The higher the score the greater the risk of mortality.
|
Total Score |
Risk Group |
Mortality Rate |
|
0 to 15 |
low risk |
16% |
|
16 to 30 |
medium risk |
48% |
|
31 to 50 |
high risk |
65% |
Specialty: Critical Care, Emergency Medicine, Cardiology
