Developing a risk prediction model for survival to discharge in cardiac arrest patients who undergo extracorporeal membrane oxygenation

• Published in: International journal of cardiology Vol. 177; no. 3; pp. 1031 - 1035
• Main Authors: Park, Sung Bum, Yang, Jeong Hoon, Park, Taek Kyu, Cho, Yang Hyun, Sung, Kiick, Chung, Chi Ryang, Park, Chi Min, Jeon, Kyeongman, Song, Young Bin, Hahn, Joo-Yong, Choi, Jin-Ho, Choi, Seung-Hyuk, Gwon, Hyeon-Cheol, Suh, Gee Young
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier B.V 20.12.2014; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Cardiology. Vascular system; Cardiopulmonary resuscitation; Cardiovascular; Extracorporeal membrane oxygenation; Extracorporeal Membrane Oxygenation - methods; Extracorporeal Membrane Oxygenation - mortality; Female; Heart; Heart Arrest - diagnosis; Heart Arrest - mortality; Heart Arrest - therapy; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Predictive Value of Tests; Predictor; Registries - statistics & numerical data; Retrospective Studies; Risk Factors; Survival Rate - trends; Predictor; Extracorporeal membrane oxygenation; Cardiopulmonary resuscitation; Human; Intensive cardiocirculatory care; Cardiocirculatory arrest; Membrane oxygenator; Prognosis; Prediction; Cardiovascular disease; Risk; Survival; Discharge; Risk factor; Models; Cardiology; Predictive factor
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2014.09.124

Abstract Background Limited data are available on a risk model for survival to discharge after extracorporeal membrane oxygenation (ECMO)-assisted cardiopulmonary resuscitation (ECPR). We aimed to develop a risk prediction model for survival to discharge in cardiac arrest patients who undergo ECMO. Methods Between January 2004 and December 2012, 505 patients supported by ECMO were enrolled in a retrospective, observational registry. Among those, we studied 152 adult patients with in-hospital cardiac arrest. The primary outcome was survival to discharge. A new predictive scoring system, named the ECPR score, was developed to monitor survival to discharge using the β coefficients of prognostic factors from the logistic model, which were internally validated. Results In-hospital death occurred in 104 patients (68.4%). In multivariate logistic regression, age ≤ 66, shockable arrest rhythm, CPR to ECMO pump-on time ≤ 38 min, post-ECMO arterial pulse pressure > 24 mm Hg, and post-ECMO Sequential Organ Failure Assessment score ≤ 14 were independent predictors for survival to discharge. Survival to discharge was predicted by the ECPR score with a c-statistics of 0.8595 (95% confidence interval [CI], 0.80–0.92; p < 0.001) which was similar to the c-statistics obtained from internal validation (training vs. test set; c-statistics, 0.86 vs. 0.86005; 95% CI, 0.80–0.92 vs. 0.77–0.94). The sensitivity and specificity for prediction of survival to discharge were 89.6% and 75.0%, respectively, when the ECPR score was > 10. Conclusions The new risk prediction model might be helpful for decisions about ECPR management and could provide better information regarding early prognosis.