Key result
IABP score ≥6 predicts ~5-fold higher 180-day mortality in postcardiotomy shock.
Why the study?
Patients requiring an IABP after cardiac surgery are critically ill with prolonged ICU stays, making it important amid limited resources to identify those with an extremely poor prognosis to guide further aggressive therapy versus therapy cessation.
Does a new scoring system predict extreme poor prognosis in patients with an intra-aortic balloon pump for postcardiotomy cardiogenic shock?
Observational (n=552)
Does a new scoring system predict extreme poor prognosis in patients with an intra-aortic balloon pump for postcardiotomy cardiogenic shock?
Answers are grounded in this paper and cite their sources.
A new scoring system aims to identify patients with extreme poor prognosis after requiring an IABP for postcardiotomy cardiogenic shock to guide therapy decisions.
Aims: Patients requiring an intra-aortic balloon pump (IABP) after cardiac surgery are critically ill and need very long ICU stay. Considering limited resources, it is important to identify patients with extreme poor prognosis to decide either a further aggressive therapy or cessation of the therapy. Methods: From 2000 to 2007, 552 patients with low-output syndrome who underwent open-heart surgery and had an IABP implanted in OR or on ICU within 24 hours from the operation were retrospectively analyzed. Results: The overall 30 days and 180 days mortality were 31% and 40%, respectively. According to multivariate analyses, following factors were used to generate an IABP score (0 to 10 points); female (+1), age ≥70 years (+1), simultaneous operation of CABG and valve surgery (+1), cardiopulmonary bypass time ≥300 minutes (+1), use of adrenalin (+1), postoperative dialysis (+2), re-thoracotomy due to bleeding (+1), laparotomy for postoperative gastroenterological complications (+1), and sepsis (+1). The 30 days and 180 days mortality in patients with score from 0 to 2 points (n=245) were 13% and 17%, respectively, those in patients with score from 3 to 5 points (n=214) were 35% and 44%, respectively, and those in patients with score ≥6 points were 69% and 86%, respectively. Conclusions: This scoring system is very simple and can identify patients with extreme poor prognosis. A high IABP score reflects a multi-organ failure in this scoring system, and a further aggressive therapy may not be profitable in patients having the IABP score ≥6 points.
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Kamiya et al. (2009) conducted an observational in Postcardiotomy cardiogenic shock / low-output syndrome requiring intra-aortic balloon pump (IABP) (n=552). IABP score ≥6 points vs. IABP score 0-2 points (and 3-5 points) was evaluated on 180-day mortality (along with 30-day mortality). An IABP score ≥6 points in postcardiotomy shock predicted 69% 30-day and 86% 180-day mortality, compared to 13% and 17% for scores of 0-2.
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