Henrik Honkanen

henrik.honkanen@stud.ki.se

@Cambio CDS

Evaluate anesthesia risk for patients undergoing cardiac surgery.

The Cardiac Anesthesia Risk Evaluation (CARE) Score is used to as a risk classification tool to predict mortality and morbidity after cardiac surgery. CARE shows similar accuracy to more complex cardiac anesthesia risk assessment schematics. It does not account for age and left ventricular (LV) function. The score contains only 6 variables (compared to EuroSCORE, which contains 18 variables) but shows similar accuracy. Scoring and interpretation is done as follows: -Score 1. In-hospital mortality 0.5% and morbidity 5.4% -Score 2. In-hospital mortality 1.1% and morbidity 10.3% -Score 3. In-hospital mortality 2.2% and morbidity 19.0% -Score 3E. In-hospital mortality 4.5% and morbidity 32.1% -Score 4. In-hospital mortality 8.8% and morbidity 48.8% -Score 4E. In-hospital mortality 16.7% and morbidity 65.8% -Score 5. In-hospital mortality 29.3% and morbidity 79.6% -Score 5E. In-hospital mortality 46.2% and morbidity 88.7% Morbidity was defined as any of the following: -Cardiovascular: low cardiac output, hypotension, or both treated with intraaortic balloon pump, with two or more intravenous inotropes or vasopressors for more than 24 h, or with both, malignant arrhythmia (asystole and ventricular tachycardia or fibrillation) requiring cardiopulmonary resuscitation, antiarrhythmia therapy, or automatic cardiodefibrillator implantation -Respiratory: mechanical ventilation for more than 48 h, tracheostomy, reintubation -Neurologic: focal brain injury with permanent functional deficit, irreversible encephalopathy -Renal: acute renal failure requiring dialysis -Infectious: septic shock with positive blood cultures, deep sternal or leg wound infection requiring intravenous antibiotics, surgical debridement, or both -Other: any surgery or invasive procedure necessary to treat a postoperative adverse event associated with the initial cardiac surgery Examples of complex cardiac surgeries: -Reoperation -Combined valve and coronary artery surgery -Multiple valve surgery -Left ventricular aneurysmectomy -Repair of VSD after MI -CABG of diffuse or heavily calcified vessels -Other, as judged by clinicians

1. Dupuis JY, Wang F, Nathan H, Lam M, Grimes S, Bourke M. The Cardiac Anesthesia Risk Evaluation ScoreA Clinically Useful Predictor of Mortality and Morbidity after Cardiac Surgery. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2001 Feb 1;94(2):194-204.

OBSERVATION.cardiac_anesthesia_risk_evaluation_score_care.v0