title: The modified SAVE score: predicting survival using urgent veno-arterial extracorporeal membrane oxygenation within 24 hours of arrival at the emergency department.
abstract: BACKGROUND
  Although many risk models have been tested in patients who undergo extracorporeal membrane oxygenation, few have been assessed for patients who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support in the emergency department (ED). This study aimed to successfully predict outcomes of patients with cardiac or noncardiac failure who received VA-ECMO in the ED within 24 hours of arrival at the ED.
  
  
  METHODS
  This retrospective, observational cohort study included 154 patients, who were classified as cardiac (n = 127) and noncardiac (n = 27) patients and received VA-ECMO within 24 hours after arrival at the China Medical University Hospital ED in Taiwan between January 2009 and September 2014. We recorded mechanical ventilation settings, arterial blood gases, laboratory parameters including plasma lactate level, requirement of catecholamines, and risk scores at time of ECMO initiation. ECMO and mechanical ventilation support duration, length of stay in the hospital, and 90-day mortality data were also examined.
  
  
  RESULTS
  The overall mortality rate was 64.9 %. We used "survival after veno-arterial ECMO (SAVE)" scores to assess survival prediction in survival and nonsurvival groups, which was statistically different (-3.2 vs. -8.3, p <0.001). According to multivariate Cox proportional regression of survival, lactate (hazard ratio [HR] = 1.01, 95 % confidence interval [CI], 1.01-1.01, p <0.001) and SAVE score (HR = 0.92, [95 % CI, 0.88-0.96], p = 0.001) were independent predictors of outcome. Excellent discrimination (area under curve (AUC) = 0.843) was observed when lactate and SAVE score were combined, which we referred to as "the modified SAVE score."
  
  
  CONCLUSIONS
  Modified SAVE scores improved outcome prediction for patients who underwent urgent VA-ECMO in the ED.
authors: Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City, 40402, Taiwan.
authors: Wei-Cheng
authors: WC
authors: Chen
authors: Division of Chest Medicine, Department of Internal Medicine, Yuanlin Christian Hospital, Changhua, Taiwan.
authors: Kuo-Yang
authors: KY
authors: Huang
authors: Division of Chest Medicine, Department of Internal Medicine, Everan Hospital, Taichung, Taiwan.
authors: Chih-Wei
authors: CW
authors: Yao
authors: Division of Cardiovascular Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan.
authors: Cing-Feng
authors: CF
authors: Wu
authors: Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City, 40402, Taiwan.
authors: Shinn-Jye
authors: SJ
authors: Liang
authors: Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City, 40402, Taiwan.
authors: Chia-Hsiang
authors: CH
authors: Li
authors: Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City, 40402, Taiwan.
authors: Chih-Yeh
authors: CY
authors: Tu
authors: Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City, 40402, Taiwan. redman0127@gmail.com.|Department of Respiratory Therapy, China Medical University, Taichung, Taiwan. redman0127@gmail.com.
authors: Hung-Jen
authors: HJ
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D015199:Extracorporeal Membrane Oxygenation / Q000145:classification* / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012044:Regression Analysis; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods / Q000592:standards*; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013624:Taiwan; D016896:Treatment Outcome
keywords: Acute respiratory distress syndrome; Cardiac failure; Critical care; Emergency; Extracorporeal membrane oxygenation; Outcome