Society for Cardiovascular Angiography and Interventions Shock Classification to Stratify Outcomes of Extracorporeal Membrane Oxygenation

Abstract

We applied the Society for Cardiovascular Angiography and Interventions (SCAI) schema to cardiogenic shock (CS) patients treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) to assess performance in this high acuity group of patients.Records of adult patients receiving VA-ECMO for CS at our institution from 01/2015 to 12/2019 were reviewed. Post-cardiotomy and noncardiogenic shock patients were excluded.A total of 245 patients were included, with a median age of 59 years [IQR: 48–67]; 159 (65%) were male. There were 34 (14%) patients in Stage C, 82 (33%) in D, and 129 (53%) in E. Of E patients, 88 (68%) were undergoing cardiopulmonary resuscitation. Median ECMO duration decreased with stage (C:7, D:6, E:4 days,P< 0.001). In-hospital mortality increased (C:35%, D:56%, E:71%,P< 0.001) and myocardial recovery decreased with stage (C:65%, D:35%, E:30%,P< 0.001). Acute kidney injury (C:35%, D:45%, E:54%,P= 0.045), acute liver failure (C:32%, D:66%, E:76%,P< 0.001), and infection (C:35%, D:28%, E:16%,P= 0.004) varied among groups. Multivariable analysis revealed age (HR=1.02), male sex (HR=0.62), and E classification (HR=2.69) as independently associated with 1-year mortality. Competing-risks regression identified D (SHR=0.53) and E classification (SHR=0.45) as inversely associated with myocardial recovery.In patients treated with VA-ECMO for CS, the SCAI classification provided robust risk stratification.