Predicting mortality in patients undergoing VA-ECMO after coronary artery bypass grafting: the REMEMBER score

• Published in: Critical care (London, England) Vol. 23; no. 1; pp. 11 - 10
• Main Authors: Wang, Liangshan, Yang, Feng, Wang, Xiaomeng, Xie, Haixiu, Fan, Eddy, Ogino, Mark, Brodie, Daniel, Wang, Hong, Hou, Xiaotong
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 11.01.2019; BioMed Central; BMC
• Subjects: Cardiogenic shock; China; Coronary artery bypass; Coronary artery bypass grafting; Coronary heart disease; Creatine kinase; Extracorporeal membrane oxygenation; Hospital admission and discharge; Medical research; Mortality; Observations; Patient outcomes; pRedicting mortality in patients undergoing veno-arterial Extracorporeal MEMBrane oxygenation after coronary artEry bypass gRafting (REMEMBER) score; Prevalence studies (Epidemiology); Shock; Venoarterial extracorporeal membrane oxygenation; Veterans hospitals; China; Cardiogenic shock; Coronary artery bypass grafting; Mortality; pRedicting mortality in patients undergoing veno-arterial Extracorporeal MEMBrane oxygenation after coronary artEry bypass gRafting (REMEMBER) score; Venoarterial extracorporeal membrane oxygenation
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1466-609X
• DOI: 10.1186/s13054-019-2307-y

Prediction scoring systems for coronary artery bypass grafting (CABG) patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) have not yet been reported. This study was designed to develop a predictive score for in-hospital mortality for cardiogenic shock patients who received VA-ECMO after isolated CABG. Retrospective cohort study of consecutive CABG patients supported with VA-ECMO (n = 166) at the Beijing Anzhen Hospital between February 2004 and March 2017. One hundred and six patients (64%) could be weaned from VA-ECMO, and 74 patients (45%) survived to hospital discharge. On the basis of multivariable logistic regression analyses, the pRedicting mortality in patients undergoing veno-arterial Extracorporeal MEMBrane oxygenation after coronary artEry bypass gRafting (REMEMBER) score was created with six pre-ECMO parameters: older age, left main coronary artery disease, inotropic score > 75, CK-MB > 130 IU/L, serum creatinine > 150 umol/L, and platelet count < 100 × 10 /L. Four risk classes, namely class I (REMEMBER score 0-13), class II (14-19), class III (20-25), and class IV (> 25) with their corresponding mortality (13%, 55%, 70%, and 94%, respectively), were identified. The area under the receiver operating characteristic curve 0.85(95% CI 0.79-0.91) for the REMEMBER score was better than those for the SOFA, SAVE, EuroSCORE, and ENCOURAGE scores in this population. The REMEMBER score might help clinicians at bedside to predict in-hospital mortality for patients receiving VA-ECMO after isolated CABG for refractory cardiogenic shock. Prospective studies are needed to externally validate this scoring system.