Radiographic assessment of lung edema (RALE) score is associated with clinical outcomes in patients with refractory cardiogenic shock and refractory cardiac arrest after percutaneous implantation of extracorporeal life support.

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Abstrakt

Tytuł:: Radiographic assessment of lung edema (RALE) score is associated with clinical outcomes in patients with refractory cardiogenic shock and refractory cardiac arrest after percutaneous implantation of extracorporeal life support.
Autorzy:: Voigt I; Department of Acute and Emergency Medicine, Elisabeth-Hospital Essen, Essen, Germany. .; Ruhr-University, Bochum, Germany. .
Mighali M; Department of Acute and Emergency Medicine, Elisabeth-Hospital Essen, Essen, Germany.
Manda D; Department of Acute and Emergency Medicine, Elisabeth-Hospital Essen, Essen, Germany.
Aurich P; Department of Acute and Emergency Medicine, Elisabeth-Hospital Essen, Essen, Germany.; Department of Cardiology and Angiology, Elisabeth-Hospital Essen, Essen, Germany.
Bruder O; Department of Cardiology and Angiology, Elisabeth-Hospital Essen, Essen, Germany.; Ruhr-University, Bochum, Germany.
Źródło:: Internal and emergency medicine [Intern Emerg Med] 2022 Aug; Vol. 17 (5), pp. 1463-1470. Date of Electronic Publication: 2022 Feb 15.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Publication: Milan : Springer
Original Publication: Rome, Italy : CEPI-AIM Group, 2006-
MeSH Terms:: Extracorporeal Membrane Oxygenation*
Heart Arrest*/etiology
Pulmonary Edema*/etiology
Pulmonary Edema*/therapy
Edema/etiology ; Humans ; Lactates ; Lung ; Respiratory Sounds/etiology ; Retrospective Studies ; Shock, Cardiogenic/therapy ; Stroke Volume ; Ventricular Function, Left
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Contributed Indexing:: Keywords: Cardiac arrest; Cardiogenic shock; Chest X-ray; Prognosis; Pulmonary edema; VA-ECMO
Substance Nomenclature:: 0 (Lactates)
Entry Date(s):: Date Created: 20220216 Date Completed: 20220808 Latest Revision: 20221029
Update Code:: 20240105
DOI:: 10.1007/s11739-022-02937-7
PMID:: 35169942
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VA-ECMO is a promising therapeutic option in refractory cardiogenic shock (RCS) and refractory cardiac arrest (RCA). However, increase in left ventricular afterload enhances further reduction of LV contractility and pulmonary edema. The aim of this study was to evaluate pulmonary edema based on the RALE score and the prognostic value of the score on ECLS weaning and mortality. In this retrospective study, data from 40 patients (16 RCAs and 24 RCSs) were analyzed. Demographic, clinical data and the RALE score for evaluating pulmonary edema were assessed. Descriptive statistics, intraclass correlation, and receiver operating characteristic (ROC) curves were computed. Weaning from ECLS was successful in 30 (75%) patients, 16 patients (40%) were discharged alive. Overall, the survivors were younger, presenting with a higher left ventricular ejection fraction (30 ± 2% vs.23 ± 9%;p < 0.01) and a lower initial serum lactate concentration 7.7 ± 4.5 mmol/l vs. 11.5 ± 4.9 mmol/l; p = 0.017). Survivors had lower RALE scores than non-survivors (16.3 ± 9.4 vs. 26.4 ± 10.4; p = 0.0034). The interobserver variability of the RALE score was good (0.832). The AUC predicting mortality and weaning from ECLS presented comparable results to the established parameters (SAVE, serum lactate). Implementation of the RALE score could support prediction of outcome parameters during VA-ECMO therapy.
(© 2022. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)

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