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. 2019 Jan 11;23(1):11.
doi: 10.1186/s13054-019-2307-y.

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

Liangshan Wang  1 , Feng Yang  1 , Xiaomeng Wang  1 , Haixiu Xie  1 , Eddy Fan  2 , Mark Ogino  3 , Daniel Brodie  4 , Hong Wang  1 , Xiaotong Hou  5
Affiliations

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

Liangshan Wang et al. Crit Care. .

Abstract

Background: 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.

Methods: Retrospective cohort study of consecutive CABG patients supported with VA-ECMO (n = 166) at the Beijing Anzhen Hospital between February 2004 and March 2017.

Results: 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 × 109/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.

Conclusions: 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.

Keywords: Cardiogenic shock; Coronary artery bypass grafting; Mortality; Venoarterial extracorporeal membrane oxygenation; pRedicting mortality in patients undergoing veno-arterial Extracorporeal MEMBrane oxygenation after coronary artEry bypass gRafting (REMEMBER) score.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the institutional ethics committee/review board of the Beijing Anzhen Hospital. Informed consent for demographic, physiological and hospital-outcome data analyses was not obtained because this observational study did not modify existing diagnostic or therapeutic strategies. However, patients and/or relatives were informed about the anonymous data collection and that they could decline inclusion.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
a Predicted mortality at each score level. Curved blue lines represent 95% confidence interval for predicted survival at each score level. b Hospital mortality by risk class. Observed mortality and predicted mortality are expressed as mean ± 95% confidence interval
Fig. 2
Fig. 2
Kaplan–Meier estimates of cumulative probabilities of 80-day survival for patients with the indicated pre-ECMO REMEMBER-score classes
Fig. 3
Fig. 3
The areas under the receiver operating characteristic curves for predicting in-hospital death. Discriminatory performance of REMEMBER score was greater than other scores
See this image and copyright information in PMC

Comment in

References

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