Patient selection: refractory cardiogenic shock, age >= 18 years
Parameters:
(1) acute cardiogenic diagnosis (5 items)
(2) age in years
(3) weight in kilograms
(4) acute pre-ECMO organ failures (3 items)
(5) chronic renal failure
(6) duration of intubation prior to initiation of ECMO in hours
(7) peak inspiratory pressure in cm H2O
(8) pre-ECMO cardiac arrest
(9) diastolic blood pressure prior to ECMO in mm Hg
(10) pulse pressure prior to ECMO in mm Hg
(11) serum bicarbonate prior to ECMO in mmol/L
|
Parameter
|
Finding
|
Points
|
|
myocarditis
|
no
|
0
|
|
|
yes
|
3
|
|
refractory VT or VF
|
no
|
0
|
|
|
yes
|
2
|
|
after heart or lung transplantation
|
no
|
0
|
|
|
yes
|
3
|
|
congenital heart diseaes
|
no
|
0
|
|
|
yes
|
-3
|
|
other diagnosis causing shock
|
no
|
0
|
|
|
yes
|
0
|
|
age in years
|
18 to 38 years
|
7
|
|
|
39 to 52 years
|
4
|
|
|
53 to 62 years
|
3
|
|
|
>= 63 years
|
0
|
|
weight in kilograms
|
< 65 kilograms
|
1
|
|
|
65 to 89 years
|
2
|
|
|
>= 90 years
|
0
|
|
acute liver failure
|
no
|
0
|
|
|
yes
|
-3
|
|
acute CNS dysfunction
|
no
|
0
|
|
|
yes
|
-3
|
|
acute renal failure
|
no
|
0
|
|
|
yes
|
-3
|
|
chronic renal failure
|
no
|
0
|
|
|
yes
|
-6
|
|
duration of intubation
|
<= 10 hours
|
0
|
|
|
11 to 29 hours
|
-2
|
|
|
>= 30 hours
|
-4
|
|
peak inspiratory pressure
|
<= 20 cm H2O
|
3
|
|
|
> 20 cm H2O
|
0
|
|
pre-ECMO cardiac arrest
|
no
|
0
|
|
|
yes
|
-2
|
|
diastolic blood pressure before ECMO
|
>= 40 mm Hg
|
3
|
|
|
< 40 mm Hg
|
0
|
|
pulse pressure before ECMO
|
> 20 mm Hg
|
0
|
|
|
<= 20 mm Hg
|
-2
|
|
bicarbonate before ECMO
|
<= 15 mmol/L
|
-3
|
|
|
> 15 mmol/L
|
0
|
total score =
= SUM(points for all of the parameters) -6
Interpretation:
• minimum score: -35
• maximum score: 17
• The higher the score the better the survival.
|
Score
|
Risk Class
|
Survival
|
|
>= 6
|
I
|
75%
|
|
1 to 5
|
II
|
58%
|
|
-4 to 0
|
III
|
42%
|
|
-9 to -5
|
IV
|
30%
|
|
<= -10
|
V
|
18%
|
