External validation of the PC-ECMO score in postcardiotomy veno-arterial extracorporeal membrane oxygenation

Author:

Biancari Fausto12ORCID,Juvonen Tatu23,Cho Sung-Min4,Hernández Pérez Francisco J5,L’Acqua Camilla67ORCID,Arafat Amr A89ORCID,AlBarak Mohammed M10,Laimoud Mohamed1112ORCID,Djordjevic Ilija13,Samalavicius Robertas1415ORCID,Alonso-Fernandez-Gatta Marta1617,Sahli Sebastian D18ORCID,Kaserer Alexander18,Dominici Carmelo19,Mäkikallio Timo1

Affiliation:

1. Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Etelä-Karjala, Finland

2. Heart and Lung Center, Helsinki University Hospital, Helsinki, Uusimaa, Finland

3. Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, Oulu, Finland

4. Divisions of Neurosciences, Critical Care and Cardiac Surgery, Departments of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

5. Puerta de Hierro University Hospital, Madrid, Spain

6. Anesthesia and Intensive Care Unit, Centro Cardiologico Monzino, Milan, Lombardy, Italy

7. Anesthesia and Intensive Care Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

8. Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia

9. Cardiothoracic Surgery Department, Tanta University, Tanta, Gharbia Governorate, Egypt

10. Intensive Care Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia

11. Cardiac Surgical Intensive Care Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

12. Critical Care Medicine Department, Cairo University, Cairo, Egypt

13. Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany

14. Second Department of Anesthesia, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania

15. Clinic of Emergency Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania

16. Cardiology Department, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Castilla y León, Spain

17. CIBER-CV Instituto de Salud Carlos III, Madrid, Spain

18. Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland

19. Department of Cardiac Surgery, Campus Biomedico, Rome, Lazio, Italy

Abstract

Reliable stratification of the risk of early mortality after postcardiotomy veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) remains elusive. In this study, we externally validated the PC-ECMO score, a specific risk scoring method for prediction of in-hospital mortality after postcardiotomy V-A-ECMO. Overall, 614 patients who required V-A-ECMO after adult cardiac surgery were gathered from an individual patient data meta-analysis of nine studies on this topic. The AUC of the logistic PC-ECMO score in predicting in-hospital mortality was 0.678 (95%CI 0.630–0.726; p < 0.0001). The AUC of the logistic PC-ECMO score in predicting on V-A-ECMO mortality was 0.652 (95%CI 0.609–0.695; p < 0.0001). The Brier score of the logistic PC-ECMO score for in-hospital mortality was 0.193, the slope 0.909, the calibration-in-the-large 0.074 and the expected/observed mortality ratio 0.979. 95%CIs of the calibration belt of fit relationship between observed and predicted in-hospital mortality were never above or below the bisector ( p = 0.072). The present findings suggest that the PC-ECMO score may be a valuable tool in clinical research for stratification of the risk of patients requiring postcardiotomy V-A-ECMO.

Publisher

SAGE Publications

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