Introduction: For critically ill children requiring extracorporeal membrane oxygenation (ECMO), survival to hospital discharge remains 50-60%. Identifying a tool that could be used to predict mortality in pediatric ECMO patients remains critical. One possible predictor is the Vasoactive-Inotropic Score (VIS), which was first identified to predict the morbidity and mortality after infant cardiopulmonary bypass but has been validated in predicting morbidity and mortality in pediatric sepsis patients. We aimed to identify if VIS can be used as a predictor of mortality in pediatric VA-ECMO patients. We also wanted to identify the association between VIS and ECMO course, ICU LOS, as well as neurocognitive outcomes.
Methods: This was a chart review study and any patient that was placed on VV ECMO at any point in their course was eliminated. Patients aged 30days-18years cannulated for cardiovascular dysfunction were included. 75 patients were identified. We collected demographic information and calculated VIS scores at 6, 12 and 24hours prior to cannulation and 6, 12, 24 and 48 hours after cannulation. Statistical analysis was done using SYSTAT 13.
Results: We found that survivors had a lower mean VIS score at both 6 and 12 hours post cannulation. At 6 hours post cannulation the mean was 25.7 and the difference was 15. At 12 hours post cannulation the difference was 26.7 with a mean of 15.6. These values had a p-value < 0.05. Using the Pearson correlation matrix, there was an r-value of 0.51 when comparing the VIS scores at 6 and 12 hours prior to cannulation. We found a correlation with an r-value of 0.53 when comparing scores at 12 and 24hours prior to cannulation. Similarly, when comparing the scores at 6 and 12hours post cannulation there was an r-value of 0.43.
Conclusions: We found that survivors had significantly lower VIS scores at 6 and 12hours post cannulation when compared to non survivors. Patients with higher VIS scores initially are likely to continue to have higher scores. This would indicate that higher scores could indicate a higher risk of decompensation and therefore, the VIS score could be a potential predictor of mortality in pediatric VA-ECMO patients. In future studies, we hope to repeat the analysis at intuitions with larger ECMO programs to determine if they would achieve similar results.
