cliot (version 1.0.0)

save_ecmo_score: SAVE Score for Veno-Arterial (VA) ECMO Survival

Description

Calculates the Survival After Veno-arterial ECMO (SAVE) Score to predict in-hospital survival for adult patients with refractory cardiogenic shock treated with VA-ECMO. The score stratifies patients into five risk classes based on 12 pre-ECMO clinical parameters.

Usage

save_ecmo_score(age, weight_kg, diagnosis_category, chronic_renal_failure,
                acute_renal_failure, liver_failure, cns_dysfunction,
                intubation_duration_hours, peak_inspiratory_pressure,
                cardiac_arrest_pre_ecmo, diastolic_bp_pre_ecmo,
                pulse_pressure_pre_ecmo, bicarbonate_pre_ecmo)

Value

A list containing:

SAVE_Score

The calculated total score (Range -35 to +17).

Risk_Class

Risk classification (Class I to V).

Est_Hospital_Survival

Estimated survival percentage.

Arguments

age

Numeric. Patient age in years.

weight_kg

Numeric. Patient weight in kg.

diagnosis_category

String. Etiology of cardiogenic shock. "chronic_heart_failure" (-5) "myocarditis" (+3) "refractory_vt_vf" (+2) "post_transplant" (+3) "congenital_heart_disease" (-3) "other" (-1) (e.g., postpartum, toxic, idiopathic)

chronic_renal_failure

Numeric (0 or 1). Chronic renal failure history (Stage 3+ or damage > 3 months). (1 = Yes, -6 pts).

acute_renal_failure

Numeric (0 or 1). Acute renal failure pre-ECMO. (1 = Yes, -3 pts).

liver_failure

Numeric (0 or 1). Liver failure (Bili >= 33 umol/L or Transaminases > 70 U/L). (1 = Yes, -3 pts).

cns_dysfunction

Numeric (0 or 1). Central nervous system dysfunction. (1 = Yes, -3 pts).

intubation_duration_hours

Numeric. Hours intubated prior to ECMO initiation. <= 10 hours (0 pts) 11-29 hours (-2 pts) >= 30 hours (-4 pts)

peak_inspiratory_pressure

Numeric. Peak inspiratory pressure (PIP) in cmH2O. (<= 20 cmH2O adds +3 pts).

cardiac_arrest_pre_ecmo

Numeric (0 or 1). Cardiac arrest prior to ECMO cannulation. (1 = Yes, -2 pts).

diastolic_bp_pre_ecmo

Numeric. Diastolic blood pressure pre-ECMO (worst value in 6h). (>= 40 mmHg adds +3 pts).

pulse_pressure_pre_ecmo

Numeric. Pulse pressure pre-ECMO (worst value in 6h). (<= 20 mmHg subtracts -2 pts).

bicarbonate_pre_ecmo

Numeric. Serum bicarbonate pre-ECMO (worst value in 6h). (<= 15 mmol/L subtracts -3 pts).

References

Schmidt M, Burrell A, Roberts L, et al. Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J. 2015;36(33):2246-2256. doi:10.1093/eurheartj/ehv162

Examples

# Example 1: Good Candidate (Class I)
# 30yo (+7), 70kg (+2), Myocarditis (+3), No Failures, 5h vent (0),
#PIP 18 (+3), No Arrest (0), DBP 60 (+3), PP 30 (0), HCO3 24 (0)
# Score = 7 + 2 + 3 + 0 + 3 + 0 + 3 = 18
save_ecmo_score(30, 70, "myocarditis", 0, 0, 0, 0, 5, 18, 0, 60, 30, 24)

# Example 2: Poor Candidate (Class V)
# 70yo (0), 80kg (+2), Chronic HF (-5), Chronic Renal (-6), 48h vent (-4),
#Arrest (-2), DBP 30 (0), PP 15 (-2), HCO3 12 (-3)
# Score = 0 + 2 - 5 - 6 - 4 - 2 - 2 - 3 = -20
save_ecmo_score(70, 80, "chronic_heart_failure", 1, 0, 0, 0, 48, 30, 1, 30, 15, 12)