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Curso de Atualização em Medicina Cardiovascular 2019
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Venoarterial extracorporeal membrane oxygenation in cardiogenic shock: Prognostic variables and performance of different clinical risk scores
Session:
Posters 4 - Écran 1 - Doença Coronária
Speaker:
Pedro Miguel Gonçalves Teixeira
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.4 Acute Cardiac Care – Cardiogenic Shock
Session Type:
Posters
FP Number:
---
Authors:
Pedro Gonçalves Teixeira; Marisa Passos Silva; Domingas Canga Mbala; Miguel Lourenço Varela; Maria Ana Canelas; Ana Raquel Barbosa; Cláudio Guerreiro; Ana Mosalina; Tiago Dias; Pedro Ribeiro Queirós; Eduardo Vilela; Ricardo Fontes-Carvalho; Marta Ponte; Gustavo Morais; Adelaide V. Dias; Alberto Rodrigues; Pedro Braga; Daniel Caeiro
Abstract
<p><strong>INTRODUCTION</strong> The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) to support patients in cardiogenic shock has been increasing in Portugal over the past few years. Nonetheless, epidemiologic, prognostic and clinical outcome data are scarce.</p> <p><strong>PURPOSE</strong> We aim to identify clinical variables with prognostic significance in this challenging population, as well as the performance of various risk scores in mortality prediction.</p> <p><strong>METHODS</strong> All patients that underwent VA-ECMO support at our Cardiac ICU between 2011 and 2018 were included in the analysis. Logistic regression analysis was used to assess the relationship between clinical variables and outcomes. All statistical analyses were conducted using IBM SPSS Statistics 25®.</p> <p><strong>RESULTS</strong> Short-term mechanical support with VA-ECMO was given to 40 patients, with a mean age of 52 ± 11 years. At the time of the implant, mean SOFA score was 11.2 ± 4.0, and mean SAVE score was -4.75 ± 4.6. Mean ECMO support duration was 116±96 hours. In 70% (N=28) of patients, VA-ECMO was successfully weaned. In-hospital mortality was observed in 52.5% of patients, which was in accordance with the predicted mortality by SOFA score (22.5% to 82% in our population risk range) and by SAVE score (60 to 70%). Those who placed the VA-ECMO as a bridge to transplant or to long-term mechanical LV assist device had greater in-hospital mortality rates (91.6 vs 41.9%, p=0.013), as well as those under ≥ 2 inotropic / vasopressors (69.2 vs 21.4%, p= 0.012) or when adrenaline use was needed (100% vs 44.1%, p=0.01). No other between-group differences were observed in what concerns short-term mortality. After logistic regression analysis, independent predictors of in-hospital mortality included AMI setting, number of vasoactive amines used, and necessity of an LV venting device. SAVE score had the greater predictive ability in these patients (AUC = 0.638) among the most utilized clinical risk scores (SOFA score AUC = 0.37; APACHE II score AUC = 0.59; SAPS II score AUC = 0.54).</p> <p><strong>CONCLUSION</strong> In our analysis, patients in profound cardiogenic shock on VA-ECMO support had slightly better survival rates than predicted by classical Risk Scores. The SAVE score may be the most accurate tool to predict in-hospital mortality in this specific, and yet heterogeneous, clinical subset. Other well recognized clinical markers of severity may also help refine short-term prognosis, and potentially improve organ transplant or other destination therapy prioritization.</p>
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