Evaluation of Vasoactive-Inotropic Score and Survival to Decannulation in Adult Patients on Venoarterial Extracorporeal Life Support: An Observational Cohort Study

Abstract

Extracorporeal life support with venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used to assist circulation in patients with severe cardiogenic shock or cardiac arrest. The vasoactive-inotropic score (VIS) is a standardized calculation of vasoactive medication support which uses coefficients for each medication that converts them to an equivalent value. The purpose of this study was to assess the VIS as an early prognostication tool for survival to decannulation patients on adult VA-ECMO support. This was a single-center, observational cohort study of adult patients who received VA-ECMO support compared based on their survival to decannulation. The primary endpoint was the VIS at hour 24 postcannulation. Among the 265 patients included in this study, 140 patients (52.8%) survived to decannulation of VA-ECMO. At 24 hours postcannulation, a lower VIS was observed in the group that survived decannulation (6.5 ± 7.5 vs. 12.3 ± 16.9; p < 0.001). Multivariate analysis performed also demonstrates an association between 24-hour VIS and survival to decannulation (odds ratio 0.95; 95% confidence interval, 0.91-0.95). This study suggests that the 24-hour VIS may be an early prognostic indicator in patients on VA-ECMO patients.

Comparison of survival by vasoactive-inotropic score in patients receiving veno-arterial extracorporeal life support

“…As reported in a previous receiver operating characteristic analysis of the same cohort, the VIS24 was significantly associated with survival to decannulation and less significantly associated with 30-day survival. 5 We did not observe a significant difference in survival to discharge between groups in our study, however the trend did not conflict with other survival results. We feel that this may be explained by the fact that our study was not designed with adequate power for this secondary outcome and there are other clinical factors that ultimately may have an effect on this outcome beyond decannulation from ECMO or even 30 days of survival in the hospital.…”

“…After reviewing the sensitivity and specificity associated with various values to potentially use as a cutoff for comparison, we chose to use the median VIS24 of 6.0 as it had a balanced sensitivity (0.551) and specificity (0.598) to predict 30-day survival. 5 We attempted to determine if this or any other VIS24 cutoff could be incorporated into a multi-factor prognostication tool for predicting outcomes after initiation of ECMO support.…”

“…This analysis is an expansion of a previously published study. 5 The study was approved by the local institutional review board (HSC-MH-21-0811). This was a single-center, retrospective, observational cohort study of adult patients who received V-A ECMO support between July 1, 2016, and June 30, 2021.…”

“…In addition, the cases were further divided into quartiles according to their VIS24. 5 Kaplan-Meier survival curves were generated to compare 30-day survival between groups, and the log-rank test was used to determine statistical significance. We performed a Cox regression analysis to compare the 30-day survival stratified by VIS24 comparator groups of interest, incorporating the covariates of age, gender, body-mass index, indication for V-A ECMO, pre-ECMO mechanical circulatory support, and past medical history of hypertension, diabetes mellitus, coronary artery disease, and chronic kidney disease.…”

“…1–4 Limited data exists on the VIS in the ECMO population; however, in a recent study, the VIS 24 h after V-A ECMO initiation (VIS24) was moderately associated with survival to decannulation. 5 In this study, we evaluated the relationship between the 30-day survival of V-A ECMO patients and VIS24.…”