PMID- 30003795
OWN - NLM
STAT- MEDLINE
DCOM- 20191217
LR  - 20220408
IS  - 2048-8734 (Electronic)
IS  - 2048-8726 (Linking)
VI  - 8
IP  - 4
DP  - 2019 Jun
TI  - Development and validation of a prognostic model for survival in patients treated 
      with venoarterial extracorporeal membrane oxygenation: the PREDICT VA-ECMO score.
PG  - 350-359
LID - 10.1177/2048872618789052 [doi]
AB  - AIMS: Several scoring systems have been introduced for prognostication after 
      initiating venoarterial extracorporeal membrane oxygenation (VA-ECMO) therapy. 
      However, static scores offer limited guidance once VA-ECMO is implanted, although 
      continued allocation of healthcare resources is critical. Patients requiring 
      continued VA-ECMO support are extremely unstable, with minimal heart function and 
      multi-organ failure in most cases. The aim of the present study was to develop 
      and validate a dynamic prognostic model for patients treated with VA-ECMO. 
      METHODS AND RESULTS: A derivation cohort included 205 all-comers undergoing 
      VA-ECMO implantation at a tertiary referral hospital (51% received VA-ECMO during 
      resuscitation and 43% had severe shock). Two prediction models based on 
      point-of-care biomarkers were developed using penalised logistic regression in an 
      elastic net approach. A validation cohort was recruited from an independent 
      tertiary referral hospital. Comparators for the prediction of hospital survival 
      were the SAVE score (area under the receiver operation characteristic curve (AUC) 
      of 0.686), the SAPS score (AUC 0.679), the APACHE score (AUC 0.662) and the SOFA 
      score (AUC 0.732) in 6-hour survivors. The 6-hour PREDICT VA-ECMO score (based on 
      lactate, pH and standard bicarbonate concentration) outperformed the comparator 
      scores with an AUC of 0.823. The 12-hour PREDICT VA-ECMO integrated lactate, pH 
      and standard bicarbonate concentration at 1 hour, 6 hours and 12 hours after ECMO 
      insertion allowed even better prognostication (AUC 0.839). Performance of the 
      scores in the external validation cohort was good (AUCs 0.718 for the 6-hour 
      score and 0.735 for the 12-hour score, respectively). CONCLUSION: In patients 
      requiring VA-ECMO therapy, a dynamic score using three point-of-care biomarkers 
      predicts hospital mortality with high reliability. Furthermore, the PREDICT 
      scores are the first scores for extracorporeal cardiopulmonary resuscitation 
      patients.
FAU - Wengenmayer, Tobias
AU  - Wengenmayer T
AD  - 1 Department of Medicine III (Interdisciplinary Medical Intensive Care), 
      University of Freiburg, Germany.
AD  - 2 Department of Cardiology and Angiology I, Heart Center Freiburg University, 
      Germany.
FAU - Duerschmied, Daniel
AU  - Duerschmied D
AD  - 1 Department of Medicine III (Interdisciplinary Medical Intensive Care), 
      University of Freiburg, Germany.
AD  - 2 Department of Cardiology and Angiology I, Heart Center Freiburg University, 
      Germany.
FAU - Graf, Erika
AU  - Graf E
AD  - 3 Institute for Medical Biometry and Statistics, University of Freiburg, Germany.
FAU - Chiabudini, Marco
AU  - Chiabudini M
AD  - 3 Institute for Medical Biometry and Statistics, University of Freiburg, Germany.
FAU - Benk, Christoph
AU  - Benk C
AD  - 4 Department of Cardiovascular Surgery, University Heart Center Freiburg, 
      Germany.
FAU - Muhlschlegel, Sven
AU  - Muhlschlegel S
AD  - 1 Department of Medicine III (Interdisciplinary Medical Intensive Care), 
      University of Freiburg, Germany.
FAU - Philipp, Alois
AU  - Philipp A
AD  - 5 Department of Cardiothoracic Surgery, University Hospital Regensburg, Germany.
FAU - Lubnow, Matthias
AU  - Lubnow M
AD  - 6 Department of Internal Medicine II, University Hospital Regensburg, Germany.
FAU - Bode, Christoph
AU  - Bode C
AD  - 1 Department of Medicine III (Interdisciplinary Medical Intensive Care), 
      University of Freiburg, Germany.
AD  - 2 Department of Cardiology and Angiology I, Heart Center Freiburg University, 
      Germany.
FAU - Staudacher, Dawid Leander
AU  - Staudacher DL
AD  - 1 Department of Medicine III (Interdisciplinary Medical Intensive Care), 
      University of Freiburg, Germany.
AD  - 2 Department of Cardiology and Angiology I, Heart Center Freiburg University, 
      Germany.
LA  - eng
PT  - Journal Article
PT  - Validation Study
DEP - 20180713
PL  - England
TA  - Eur Heart J Acute Cardiovasc Care
JT  - European heart journal. Acute cardiovascular care
JID - 101591369
SB  - IM
MH  - Aged
MH  - Extracorporeal Membrane Oxygenation/*methods
MH  - Female
MH  - Follow-Up Studies
MH  - Germany/epidemiology
MH  - Hospital Mortality/trends
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - ROC Curve
MH  - Retrospective Studies
MH  - Risk Assessment/*methods
MH  - Shock, Cardiogenic/*mortality/therapy
MH  - Survival Rate/trends
MH  - Time Factors
OTO - NOTNLM
OT  - ECLS
OT  - ECMO
OT  - VA-ECMO
OT  - cardiogenic shock
OT  - eCPR
OT  - prognosis
EDAT- 2018/07/14 06:00
MHDA- 2019/12/18 06:00
CRDT- 2018/07/14 06:00
PHST- 2018/07/14 06:00 [pubmed]
PHST- 2019/12/18 06:00 [medline]
PHST- 2018/07/14 06:00 [entrez]
AID - 10.1177/2048872618789052 [doi]
PST - ppublish
SO  - Eur Heart J Acute Cardiovasc Care. 2019 Jun;8(4):350-359. doi: 
      10.1177/2048872618789052. Epub 2018 Jul 13.