Cardiac Surgery Score (CASUS) for Outcome Prediction in Patients Treated with Extra Corporal Life Support (ECLS)

Objectives: The often unexpected necessity of extracorporeal life support (ECLS) implies that information on patients and end-organ functions at time of implantation is scarce. However, there is a need for early prognostic indicators and a score with regard to outcome. Therefore, we evaluated established laboratory parameters and the most widely used intensive care scores for cardiac patients - cardiac surgery score (CASUS) and sequential organ failure assessment (SOFA) after ECLS implantation.

Methods: In this retrospective analysis, 89 consecutive adult patients with veno-arterial ECLS were included. Baseline demographic data, laboratory markers, CASUS and SOFA were acquired on the first day after ECLS implantation.

Results: A total of 61 patients (67.8%) could be weaned from ECLS and 48 patients (53.3%) were discharged from hospital. Four patients were switched to a left ventricular assist device. The outcome did not depend on indication for ECLS. Furthermore, multiple logistic regression identified lactate (HR 1.08) and PTT (HR 1.02) as independent predictors of hospital mortality. Evaluating intensive care scores, CASUS (AUROC 0.68; 95% CI: 0.57–0.77; p = 0.0024) had a higher prognostic relevance in comparison with SOFA (AUROC 0.58; 95% CI: 0.47–0.69; p = 0.187).

Conclusion: Our data indicate that lactate and PTT are independent predictors and the CASUS on the first day after ECLS initiation can improve in-hospital outcome prediction for ECLS patients.