title: Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score.
abstract: BACKGROUND
  Extracorporeal membrane oxygenation (ECMO) may provide mechanical pulmonary and circulatory support for patients with cardiogenic shock refractory to conventional medical therapy. Prediction of survival in these patients may assist in management of these patients and comparison of results from different centers.
  
  
  OBJECTIVE
  To identify pre-ECMO factors which predict survival from refractory cardiogenic shock requiring ECMO and create the survival after veno-arterial-ECMO (SAVE)-score.
  
  
  RESULTS
  Patients with refractory cardiogenic shock treated with veno-arterial ECMO between January 2003 and December 2013 were extracted from the international Extracorporeal Life Support Organization registry. Multivariable logistic regression was performed using bootstrapping methodology with internal and external validation to identify factors independently associated with in-hospital survival. Of 3846 patients with cardiogenic shock treated with ECMO, 1601 (42%) patients were alive at hospital discharge. Chronic renal failure, longer duration of ventilation prior to ECMO initiation, pre-ECMO organ failures, pre-ECMO cardiac arrest, congenital heart disease, lower pulse pressure, and lower serum bicarbonate (HCO3) were risk factors associated with mortality. Younger age, lower weight, acute myocarditis, heart transplant, refractory ventricular tachycardia or fibrillation, higher diastolic blood pressure, and lower peak inspiratory pressure were protective. The SAVE-score (area under the receiver operating characteristics [ROC] curve [AUROC] 0.68 [95%CI 0.64-0.71]) was created. External validation of the SAVE-score in an Australian population of 161 patients showed excellent discrimination with AUROC = 0.90 (95%CI 0.85-0.95).
  
  
  CONCLUSIONS
  The SAVE-score may be a tool to predict survival for patients receiving ECMO for refractory cardiogenic shock (www.save-score.com).
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, Melbourne, Australia Medical-Surgical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie CURIE, PARIS 6 47 bd de l'Hopital, Paris 75651, France matthieu.schmidt@psl.aphp.fr.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Schmidt
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, Melbourne, Australia Intensive Care Department, Alfred Hospital, Melbourne, Australia.
authors.forename: Aidan
authors.initials: A
authors.lastname: Burrell
authors.affiliation: Intensive Care Department, Alfred Hospital, Melbourne, Australia.
authors.forename: Lloyd
authors.initials: L
authors.lastname: Roberts
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, Melbourne, Australia Intensive Care Department, Alfred Hospital, Melbourne, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Bailey
authors.affiliation: Intensive Care Department, Alfred Hospital, Melbourne, Australia.
authors.forename: Jayne
authors.initials: J
authors.lastname: Sheldrake
authors.affiliation: Extracorporeal Life Support Organization, Ann Arbor, MI, USA.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Rycus
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, Melbourne, Australia Intensive Care Department, Alfred Hospital, Melbourne, Australia.
authors.forename: Carol
authors.initials: C
authors.lastname: Hodgson
authors.affiliation: Intensive Care Department, Alfred Hospital, Melbourne, Australia.
authors.forename: Carlos
authors.initials: C
authors.lastname: Scheinkestel
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, Melbourne, Australia Intensive Care Department, Alfred Hospital, Melbourne, Australia.
authors.forename: D Jamie
authors.initials: DJ
authors.lastname: Cooper
authors.affiliation: Extracorporeal Life Support Organization, Ann Arbor, MI, USA Department of Cardiology, Children's Hospital, Boston, USA Department of Pediatrics, Harvard Medical School, Boston, USA.
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Thiagarajan
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Columbia College of Physicians and Surgeons, New York, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Brodie
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, Melbourne, Australia Intensive Care Department, Alfred Hospital, Melbourne, Australia.
authors.forename: Vincent
authors.initials: V
authors.lastname: Pellegrino
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, Melbourne, Australia Intensive Care Department, Alfred Hospital, Melbourne, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Pilcher
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D012770:Shock, Cardiogenic / Q000401:mortality / Q000628:therapy*; D055815:Young Adult
keywords: Cardiogenic shock; Extracorporeal membrane; Outcome