Abstract Background Electrical storm (ES) is a highly heterogeneous condition with wide-ranging clinical presentations. The absence of standardized classification hampers risk stratification and limits effective multidisciplinary coordination. Objective To develop a classification system based on simple clinical characteristics and stratify 30-day mortality in ES patients. Methods Patients admitted to intensive care units for ES between 2010-2023 across four tertiary centers were retrospectively included. The five-stage STORM severity-response classification, based on treatment intensity during hospitalization, incorporated four clinically relevant parameters: signs of acute heart failure or hemodynamic instability, need for inotropes or vasopressors, use of advanced supportive therapies (including deep sedation) and renal replacement therapy, and implementation of mechanical circulatory support. The primary outcome was all-cause mortality at 30 days. Results 788 patients were included. The cohort was predominantly male (84.3%), with median age 66.0 years (57.0–74.0). The majority had ischemic cardiomyopathy (65.6%), with median LVEF 30.0% (20.0–45.0). According to the STORM classification, 421 patients (53.4%) were categorized as STORM-1, 45 (5.7%) as STORM-2, 86 (10.9%) as STORM-3, 220 (27.9%) as STORM-4, and 16 (2.0%) as STORM-5. Overall, 117 patients (14.8%) died within 30 days. A stepwise increase in 30-day mortality was observed across STORM stages—5.0%, 6.7%, 20.9%, 30.5%, and 50.0% for stages 1 through 5, respectively (p0.01). Conclusion The STORM classification may facilitate standardized multidisciplinary management strategies and effectively stratifies 30-day mortality risk in ES patients, ranging from 5% in stage 1 to 50% in stage 5. Further prospective studies are warranted to validate our findings.
Martins et al. (Wed,) studied this question.