• 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, and Dirk Westermann.
• Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany. Electronic address: m.becher@uke.de.
• J Crit Care. 2020 Apr 1; 56: 100-105.

PurposeVenoarterial 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 MethodsWe 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.ResultsOf 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).ConclusionsThe ECMO-ACCEPTS score might help clinicians to improve risk prediction among VA-ECMO patients for refractory cardiogenic shock.Copyright © 2019 Elsevier Inc. All rights reserved.

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