The ECMO-PoCS Score: Derivation and Internal Validation of an Implantation-Time Model for In-Hospital Mortality in Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation.

Authors

Iratxe Zarragoikoetxea, Paula Isabel Carmona, Carlos Domínguez, Ana María Bel, Miguel Ángel Ródenas, Miguel José Vargas, Jaume Agüero, Raquel López, Ignacio Moreno, María Azucena Pajares

Published in

Journal of cardiothoracic and vascular anesthesia. Oct 15, 2026. Epub Oct 15, 2026.

Abstract

To derive and internally validate a mortality score (ECMO-PoCS) for use at venoarterial extracorporeal membrane oxygenation (VA-ECMO) implantation for postcardiotomy cardiogenic shock (PCS), hypothesizing that a few implantation-time variables would discriminate in-hospital mortality better than European System for Cardiac Operative Risk Evaluation II (EuroSCORE II), Acute Physiology and Chronic Health Evaluation II (APACHE II), or pre-ECMO lactate.
Retrospective, single-center cohort study.
Tertiary cardiac surgical center.
A total of 149 consecutive adults receiving VA-ECMO for PCS (2007-2024), excluding 7 bridged directly to transplantation.
None.
Hospital mortality was 65.8% and 1-year survival 33.4%. A 4-variable logistic model (age, pre-ECMO lactate, peripheral artery disease [PAD], and any preoperative right ventricular [RV] dysfunction) was fitted in 133 complete cases; PAD (adjusted odds ratio [OR] = 4.58; p = 0.022) and RV dysfunction (adjusted OR = 3.16; p = 0.020) were independently associated with mortality. In 130 patients with all comparators, ECMO-PoCS (area under the curve [AUC] = 0.715) discriminated better than European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) (0.583; DeLong p = 0.043) and lactate alone (0.601; p = 0.030) but not significantly better than APACHE II (0.610; p = 0.13); adding these variables to APACHE II increased its AUC to 0.727 (likelihood ratio p = 0.002). Bootstrap optimism-corrected AUC was 0.687 and the shrinkage factor 0.82. A 0- to 5-point score defined low-, intermediate-, and high-risk groups (mortality 23.1%, 63.6%, and 86.0%, respectively; trend p < 0.001).
ECMO-PoCS, based on 4 variables available at implantation, discriminated in-hospital mortality better than EuroSCORE II and lactate alone and added information to APACHE II. Internally validated only, it is intended for risk description, research stratification, and benchmarking, not for decisions to initiate or withdraw support, pending external validation.

PMID:
43003726
Bibliographic data and abstract were imported from PubMed on 10 Nov 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.