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Risk prediction of in-hospital mortality in patients with venoarterial extracorporeal membrane oxygenation for cardiopulmonary support: The ECMO-ACCEPTS score

Purpose - Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an increasingly used treatment option for patients in need of mechanical cardiopulmonary support, while available outcome data is limited. The aim of this study was to identify predictors for 30-day in-hospital mortality. - Mate...

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Main Authors: Becher, Peter Moritz (Author) , Twerenbold, Raphael (Author) , Schrage, Benedikt (Author) , Schmack, Bastian (Author) , Sinning, Christoph R. (Author) , Fluschnik, Nina (Author) , Schwarzl, Michael (Author) , Waldeyer, Christoph (Author) , Seiffert, Moritz (Author) , Clemmensen, Peter (Author) , Neumann, Johannes T. (Author) , Bernhardt, Alexander M. (Author) , Zeymer, Uwe (Author) , Thiele, Holger (Author) , Reichenspurner, Hermann (Author) , Blankenberg, Stefan (Author) , Westermann, Dirk (Author)
Format: Article (Journal)
Language:English
Published: 2020
In: Journal of critical care
Year: 2019, Volume: 56, Pages: 100-105
ISSN:1557-8615
DOI:10.1016/j.jcrc.2019.12.013
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.jcrc.2019.12.013
Verlag, lizenzpflichtig, Volltext: http://www.sciencedirect.com/science/article/pii/S0883944119315722
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Author Notes:Peter M. Becher, Raphael Twerenbold, Benedikt Schrage, Bastian Schmack, Christoph R. Sinning, Nina Fluschnik, Michael Schwarzl, Christoph Waldeyer, Moritz Seiffert, Peter Clemmensen, Johannes T. Neumann, Alexander M. Bernhardt, Uwe Zeymer, Holger Thiele, Hermann Reichenspurner, Stefan Blankenberg, Dirk Westermann
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Summary:Purpose - Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an increasingly used treatment option for patients in need of mechanical cardiopulmonary support, while available outcome data is limited. The aim of this study was to identify predictors for 30-day in-hospital mortality. - Material and methods - We analyzed baseline characteristics and outcomes of 8351 VA-ECMO procedures performed in Germany from 2007 to 2015. Using a multivariable model, we identified the ten most important variables to allow for prediction of 30-day in-hospital mortality. Based on these variables, we created a mortality prediction score (ECMO-ACCEPTS score) to enhance decision making in patients considered for or treated with VA-ECMO support. - Results - Of 8351 patients (71.7% male) 3567 had prior CPR. Mean age was 62 years in the present cohort. The overall 30-day in-hospital mortality was 61%. The ECMO-ACCEPTS score, derived among randomly selected 4175 patients, included ten independent predictors for in-hospital mortality. Internal validation in the remaining 4176 patients confirmed strong differentiation between low and high risk of 30-day in-hospital mortality (r = 0.97 for correlation of predicted with observed mortality, p < .001). - Conclusions - The ECMO-ACCEPTS score might help clinicians to improve risk prediction among VA-ECMO patients for refractory cardiogenic shock.
Item Description:Available online 13 December 2019
Gesehen am 07.04.2020
Physical Description:Online Resource
ISSN:1557-8615
DOI:10.1016/j.jcrc.2019.12.013

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