Champion reported the CRASH (Catecholamine Refractoriness and Assistance guide based on cardiogenic Shock Hemodynamics) score for evaluating a patient with cardiogenic shock undergo extracorporeal membrane oxygenation (ECMO) support. This is a measure of cardiac reserve. The author is from the Reanimation Clinique de Parly in France.
Patient selection: cardiogenic shock on ECMO
Parameters:
(1) cardiac power index (CPI, in W per meter square)
(2) inotropic score in micrograms per kilograms per minute
CRASH =
= (CPI) / SQRT (1 + (inotropic score))
inotropic score =
= ((dobutamine in micrograms/min) + (dopamine in micrograms/min) + (100 * (norepinephrine in micrograms/min)) + (100 * (epinephrine in micrograms/min)) + (15 * (IPDE-3 in micrograms/min)) + (10 * (levosimendam in micrograms/min))) / (body mass in kilograms)
Interpretation:
• The liberal threshold is 0.0375.
• The restrictive threshold is 0.0300.
Performance:
• The sensitivity is 68% with a specificity of 92% for death or ECMO.
• The area under the ROC curve is 0.85.
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