SAVE_score v.1

An assessment score used to predict in-hospital survival in adult patients after veno-arterial ECMO for refractory cardiogenic shock.

Rashmi Damodaran

rashmi.damodaran@cambio.se

© Cambio CDS

To calculate SAVE score.

Use to stratify patients to Risk classes (I-V) and predict in-hospital survival after VA ECMO for refractory cardiogenic shock based on the calculated SAVE score. Formula: Addition of selected points minus 6. Variable Points Age, years 18-38 7 39-52 4 53-62 3 >= 63 0 Weight 65-89 kg 2 <65 kg 1 >89 kg 0 Acute cardiogenic shock diagnosis group* Myocarditis 3 Refractory VT/VF 2 Post heart or lung transplantation 3 Congenital heart disease -3 Renal Acute renal failure -3 Chronic renal failure -6 HCO₃ before ECMO ≤15 mmol/L** -3 Respiratory Duration of intubation prior to initiation of ECMO, hrs ≤10 0 11-29 -2 ≥30 -4 Peak inspiratory pressure ≤20 cm H₂O (≤2.0 kPa) 3 Cardiac Pre-ECMO cardiac arrest -2 Diastolic blood pressure before ECMO ≥40 mmHg** 3 Pulse pressure before ECMO ≤20 mmHg** -2 Other organ failures pre-ECMO Liver failure -3 CNS dysfunction -3 *If any other cause of cardiogenic shock, no points are added. **Worse value within 6 hours prior ECMO cannulation. Note: - Liver failure was defined as bilirubin ≥33 µmol/L or elevation of serum aminotransferases (ALT or AST)>70 UI/L. - CNS dysfunction combined neurotrauma, stroke, encephalopathy, cerebral embolism, as well as seizure and epileptic syndromes. - Renal dysfunction is defined as acute renal insufficiency (e.g. creatinine >1.5 mg/dL) with or without RRT. - Chronic kidney disease is defined as either kidney damage or glomerular filtration rate <60 mL/min/1.73 m2 for ≥3 months. Interpretations: SAVE Score Risk class In-hospital survival >5 I 75% 1 to 5 II 58% -4 to 0 III 42% -9 to -5 IV 30% ≤-10 V 18%

Not to be used in patients receiving veno-venous (VV) ECMO.

1. Schmidt M, Burrell A, Roberts L, Bailey M, Sheldrake J, Rycus PT, Hodgson C, Scheinkestel C, Cooper DJ, Thiagarajan RR, Brodie D, Pellegrino V, Pilcher D. Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J. 2015 Sep 1;36(33):2246-56. doi: 10.1093/eurheartj/ehv194. Epub 2015 Jun 1. PMID: 26033984.

OBSERVATION.save_score.v0, EVALUATION.save_score_assessment.v0