Abstract 1225 Comparison of mortality risk models in patients with post-cardiac arrest cardiogenic shock and percutaneous mechanical circulatory support

Background

Although scoring systems are widely used to predict outcome in post-cardiac arrest cardiogenic shock (CS) after out of hospital cardiac arrest (OHCA) complicating acute myocardial infarction (AMI), data concerning the accuracy of these scores to predict mortality of patients treated with Impella in this setting are lacking. Thus, we aimed to evaluate as well as to compare the prognostic accuracy of the Acute-Physiology-And-Chronic-Health II (APACHE II), the Simplified-Acute-Physiology-Score II (SAPS II), the Sepsis-related-organ-failure-assessment (SOFA), the intra-aortic-balloon-pump (IABP), the CardShock, the prediction-of-Cardiogenic-shock-Outcome-foR-AMI-patients-salvaGed by VA-ECMO (ENCOURAGE) and the Survival-after -Veno-Arterial-extracorporeal-membranoxygenation (SAVE) score in patients with OHCA refractory CS due to an AMI treated with Impella 2.5 or CP.

Methods

Retrospective study of 65 consecutive Impella 2.5 and 32 CP patients treated in our cardiac arrest center from September 2015 until June 2020.

Results

Overall survival to discharge was 44.3%. The expected mortality according to scores was: SOFA 70%, SAPS II 90%, IABP Shock 55%, CardShock 80%, APACHE II 85%, ENCOURAGE 50% and SAVE score 70% in the 2.5 group; SOFA 70%, SAPS II 85%, IABP Shock 55%, CardShock 80%, APACHE II 85%, ENCOURAGE 75% and SAVE score 70% in the CP group. The ENCOURAGE score was the most effective predictive model of mortality outcome presenting a moderate area under curve (AUC) of 0.79, followed by the CardShock, APACHE II, IABP and SAPS score. These derived an AUC between 0.71 and 0.78. The SOFA and the SAVE scores failed to predict outcome in this particular setting of refractory CS after OHCA due to an AMI (Figures 1 and 2).

Conclusion

The available intensive care and newly developed CS scores offered only a moderate prognostic accuracy for outcome in OHCA patients with refractory CS due to an AMI treated with Impella. A new score is needed in order to guide the therapy in these patients.

Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Comparison of mortality risk models in patients with post-cardiac arrest cardiogenic shock and percutaneous mechanical circulatory support
G. Chatzis¹, B. Markus², H. Ahrens¹, U. Lüsebrink¹, C. Wächter¹, D. Divchev¹, K. Karatolios³, B. Schieffer², S. Syntila²
¹Klinik für Innere Medizin - Schwerpunkt Kardiologie, Universitätsklinikum Giessen und Marburg GmbH, Marburg; ²Klinik für Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum Giessen und Marburg GmbH, Marburg; ³IPZ Gießen, Internistisches Praxiszentrum, Gießen;
Background Although scoring systems are widely used to predict outcome in post-cardiac arrest cardiogenic shock (CS) after out of hospital cardiac arrest (OHCA) complicating acute myocardial infarction (AMI), data concerning the accuracy of these scores to predict mortality of patients treated with Impella in this setting are lacking. Thus, we aimed to evaluate as well as to compare the prognostic accuracy of the Acute-Physiology-And-Chronic-Health II (APACHE II), the Simplified-Acute-Physiology-Score II (SAPS II), the Sepsis-related-organ-failure-assessment (SOFA), the intra-aortic-balloon-pump (IABP), the CardShock, the prediction-of-Cardiogenic-shock-Outcome-foR-AMI-patients-salvaGed by VA-ECMO (ENCOURAGE) and the Survival-after -Veno-Arterial-extracorporeal-membranoxygenation (SAVE) score in patients with OHCA refractory CS due to an AMI treated with Impella 2.5 or CP. Methods Retrospective study of 65 consecutive Impella 2.5 and 32 CP patients treated in our cardiac arrest center from September 2015 until June 2020. Results Overall survival to discharge was 44.3%. The expected mortality according to scores was: SOFA 70%, SAPS II 90%, IABP Shock 55%, CardShock 80%, APACHE II 85%, ENCOURAGE 50% and SAVE score 70% in the 2.5 group; SOFA 70%, SAPS II 85%, IABP Shock 55%, CardShock 80%, APACHE II 85%, ENCOURAGE 75% and SAVE score 70% in the CP group. The ENCOURAGE score was the most effective predictive model of mortality outcome presenting a moderate area under curve (AUC) of 0.79, followed by the CardShock, APACHE II, IABP and SAPS score. These derived an AUC between 0.71 and 0.78. The SOFA and the SAVE scores failed to predict outcome in this particular setting of refractory CS after OHCA due to an AMI (Figures 1 and 2). Conclusion The available intensive care and newly developed CS scores offered only a moderate prognostic accuracy for outcome in OHCA patients with refractory CS due to an AMI treated with Impella. A new score is needed in order to guide the therapy in these patients.
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