Prognosticating Mortality of Primary Cardiogenic Shock Requiring Extracorporeal Life Support: The RESCUE Score

Tarzia, Vincenzo; Bagozzi, Lorenzo; Ponzoni, Matteo; Pradegan, Nicola; Banchelli, Federico; Bortolussi, Giacomo; Bellanti, Ermanno; Bianco, Roberto; Zanella, Fabio; Bottio, Tomaso; Gregori, Darío; Gerosa, Gino

doi:10.1016/j.cpcardiol.2022.101554

Cited by 5 publications

(4 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In line with this, Tariza et al investigated the prognostic role of a biomarker-based score for improved risk prediction in patients undergoing MCS insertion for ECLS. Their “RESCUE” score was created using platelet count creatinine and bilirubin to predict the risk of mortality, including 208 patients, taking into account the worst laboratory value within the first nine days of admission, revealing reliable discrimination of all-cause mortality in patients undergoing ECLS (corresponding AUC 0.763) [ 20 ]. However, dynamic changes in liver enzymes were not taken into account in these studies.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, an early increase in bilirubin levels (i.e., after 2 h of MCS insertion) was observed in non-survivors compared to survivors within 103 patients treated with extracorporeal life support (ECLS), whereas other liver enzymes, such as AST, did not differ [ 19 ]. In line with this, the “RESCUE” score, including bilirubin, was developed to predict the early risk of mortality in patients treated with ECLS [ 20 ]. In contrast, a comprehensive analysis of the AST/ALT ratio and bilirubin is not yet available.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prognostic Value of the AST/ALT Ratio versus Bilirubin in Patients with Cardiogenic Shock

Schupp

Rusnak

Weidner

et al. 2023

JCM

View full text Add to dashboard Cite

This study investigates the prognostic value of the aspartate-to-alanine aminotransferase ratio (i.e., AST/ALT ratio) and bilirubin in patients with cardiogenic shock (CS). Despite ongoing improvements regarding the treatment of CS patients, invasive care unit (ICU) mortality in CS patients remains unacceptably high. Limited data regarding the prognostic value of the AST/ALT ratio and bilirubin in patients suffering from CS is available. The authors hypothesize the measurement of liver enzymes during the course of CS may be an easy and feasible method to assess right-heart dysfunction and prognosis in patients with CS. Consecutive patients with CS from 2019 to 2021 were included. Blood samples were retrieved from the day of disease onset (day 1), days 2, 3, 4 and 8. The prognostic value of the AST/ALT ratio and bilirubin was tested for 30-day all-cause mortality. Statistical analyses included univariable t-tests, Spearman’s correlations, Kaplan–Meier analyses, as well as multivariable Cox proportional regression analyses. A total of 157 CS patients were included, with an overall rate of all-cause mortality at 30 days of 51%. The median AST/ALT ratio on day 1 was 1.4, and the median bilirubin was 0.63 mg/dL. No association of the baseline AST/ALT ratio (HR = 1.005; 95% CI 0.649–1.558; p = 0.981) and bilirubin (HR = 1.320; 95% CI 0.834–2.090; p = 0.236) with the risk of 30-day all-cause mortality was found. In contrast, the AST/ALT ratio on day 4 was associated with the risk of 30-day all-cause mortality (HR = 2.826; 95% CI 1.227–6.510; p = 0.015), which was still evident after the multivariable adjustment (HR = 2.830; 95% CI 1.054–7.690; p = 0.039). The AST/ALT ratio during the course of ICU hospitalization from day 4—but not the baseline AST/ALT ratio and bilirubin—was associated with an increased risk of 30-day all-cause mortality in CS patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prognostic Value of the AST/ALT Ratio versus Bilirubin in Patients with Cardiogenic Shock

Schupp

Rusnak

Weidner

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

“…Moreover, another study mentioned that platelets count, bilirubin and creatinine levels were predictors of in-hospital mortality after ECMO implantation [ 30 ]. In addition, Kohs et al found that severe thrombocytopenia was associated with adverse outcomes in patients on ECMO [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

ECMO Retrieval Program: What Have We Learned So Far

Krasivskyi

Großmann

Dechow

et al. 2023

Life

View full text Add to dashboard Cite

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used for patients with cardiogenic shock or cardiac arrest. However, survival rates remain low. It is unclear to what extent ECMO patients benefit from the ECMO team learning curve. Therefore, we aimed to analyze our mobile ECMO program patients from the past seven years to evaluate if a learning curve benefits patients’ outcomes. We analyzed 111 patients from our databank who were supported with a VA-ECMO and brought to our hospital from January 2015 to December 2021. Patients were divided into two groups: survival (n = 70) and non-survival (n = 41). As expected, complications after ECMO implantation were more severe in the non-survivor group. The incidence of thromboembolic events (p = 0.002), hepatic failure (p < 0.001), renal failure (p = 0.002), dialysis (p = 0.002) and systemic inflammatory response syndrome (SIRS, p = 0.044) occurred significantly more often compared with the survivor group. We were able to show that despite our extensive experience in terms of ECMO retrieval program the high mortality and morbidity rates stay fairly the same over the years. This displays that we have to focus even more on patient selection and ECMO indication.

show abstract

“…After the first 9 days of ECMO support, the patient's survival displays significant attrition [1], especially if MCS is not able to preserve the multi-organ status adequately [26]. When myocardial recovery is unlikely and the patient possesses temporary or absolute contraindications to heart transplantation, an MCS upgrade should be planned.…”

Section: Discussionmentioning

confidence: 99%

Test Bench for Right Ventricular Failure Reversibility: The Hybrid BiVAD Concept

Tarzia,

Ponzoni,

Pittarello

et al. 2023

JCM

Self Cite

View full text Add to dashboard Cite

Background: When heart transplantation and myocardial recovery are unlikely, patients presenting with biventricular cardiogenic shock initially treated with extracorporeal membrane oxygenation (ECMO) may benefit from a mechanical support upgrade. In this scenario, a micro-invasive approach is proposed: the combination of the double-lumen ProtekDuo cannula (Livanova, London, UK) and the Impella 5.5 (Abiomed, Danvers, MA) trans-aortic pump that translates into a hybrid BiVAD. Methods: All consecutive ECMO patients presenting with biventricular cardiogenic shock and ineligibility to heart transplantation from August 2022 were prospectively enrolled. The clinical course, procedural details, and in-hospital events were collected via electronic medical records. Results: A total of three patients, who were temporarily not eligible for heart transplantation or durable LVAD due to severe acute pneumonia and right ventricular (RV) dysfunction, were implanted with a hybrid BiVAD. This strategy provided high-flow biventricular support while pulmonary function ameliorated. Moreover, by differentially sustaining the systemic and pulmonary circulation, it allowed for a more adequate reassessment of RV function. All the patients were considered eligible for isolated durable LVAD and underwent less invasive LVAD implantation paired with a planned postoperative RVAD. In all cases, RV function gradually recovered and the RVAD was successfully removed. Conclusions: The Hybrid BiVAD represents an up-to-date micro-invasive mechanical treatment of acute biventricular failure beyond ECMO. Its rationale relies on more physiological circulation across the lungs, the complete biventricular unloading, and the possibility of including an oxygenator in the circuit. Finally, the independent and differential control of pulmonary and systemic flows allows for more accurate RV function evaluation for isolated durable LVAD eligibility reassessment.

show abstract

Prognosticating Mortality of Primary Cardiogenic Shock Requiring Extracorporeal Life Support: The RESCUE Score

Cited by 5 publications

References 40 publications

Prognostic Value of the AST/ALT Ratio versus Bilirubin in Patients with Cardiogenic Shock

Prognostic Value of the AST/ALT Ratio versus Bilirubin in Patients with Cardiogenic Shock

ECMO Retrieval Program: What Have We Learned So Far

Test Bench for Right Ventricular Failure Reversibility: The Hybrid BiVAD Concept

Contact Info

Product

Resources

About