We use cookies to understand how you use our site and to improve your experience. This includes personalizing content and advertising. To learn more, click here. By continuing to use our site, you accept our use of cookies. Cookie Policy.

Features Partner Sites Information LinkXpress hp
Sign In
Advertise with Us
ARAB HEALTH - INFORMA

Download Mobile App




Simple Risk Score Model Helps Wean Patients from Mechanical Circulatory Support

By HospiMedica International staff writers
Posted on 23 Oct 2024
Print article
Image: New risk scoring method for predicting mechanical circulatory support devices weaning success (Photo courtesy of Sho Suzuki/Shinshu University)
Image: New risk scoring method for predicting mechanical circulatory support devices weaning success (Photo courtesy of Sho Suzuki/Shinshu University)

Patients experiencing severe heart failure or cardiogenic shock often require support from mechanical circulatory support (MCS) devices, such as venoarterial extracorporeal membrane oxygenation (VA-ECMO) or the IMPELLA heart pump. These devices help ensure adequate blood flow to vital organs when the heart is too weak to function independently. A crucial part of the recovery process for these patients is assessing when their heart has regained enough strength to operate on its own, allowing for a gradual reduction in external support or weaning off the devices. Currently, physicians determine whether a patient can be weaned off MCS by monitoring essential health indicators, including blood pressure, cardiac output, and left ventricular ejection fraction (LVEF), which assess the heart's ability to pump blood effectively. Although these parameters are recognized as important for guiding the weaning process, there is a lack of standardized protocols or guidelines, making the decision of when to safely wean patients a significant challenge. Researchers have now developed a simple risk score model that utilizes easily measurable health indicators to predict the success of MCS weaning.

Instead of relying on complicated and invasive tests to assess heart function, the method developed by researchers from Shinshu University School of Medicine (Nagano, Japan) is simple and safe, making it feasible to implement for most hospitals. In their study published in Journal of Cardiac Failure, the researchers proposed a simple risk score to predict the successful weaning of patients with cardiogenic shock from MCS. They utilized metrics that guide the weaning process from real-world clinical data to formulate the risk score. Conducting a retrospective single-center cohort study, the researchers analyzed data from 114 patients with cardiogenic shock who received treatment with either VA-ECMO or the IMPELLA heart pump between January 2013 and June 2023. They evaluated patient data and outcomes related to weaning decisions made by a multidisciplinary heart team, which included cardiologists and cardiovascular surgeons. A patient was deemed successfully weaned from MCS if the device was removed (or decannulation was performed) without the need for re-implantation and the patient survived until discharge from the hospital.

Out of the total cohort, 86 patients underwent the weaning procedure, and 55 were successfully weaned off MCS. Those who were not weaned had a higher incidence of acute myocardial infarction (AMI) and poorer health indicators. Their average blood pressure was lower (71 mm Hg) compared to those who successfully weaned (85 mm Hg), and they had a reduced pulse pressure (38 ± 20 mm Hg versus 50 ± 19 mm Hg) and weaker heart function (30% versus 40% LVEF). Additionally, they presented with elevated lactate levels in their blood (11 mg/dL versus 9 mg/dL) and longer QRS durations (106 ms vs. 92 ms), indicating slower electrical activity in the heart's ventricles. Utilizing these variables (AMI, mean blood pressure, lactate, QRS duration, and LVEF), the researchers developed two risk score formulas: one for general weaning and a simplified version.

The simplified version, known as the simple MCS weaning score, classifies patients into five groups based on their success rates by summing the points linked to each risk factor. A score of 0 or 1 indicates the absence of risk factors, corresponding to a 100% success rate; 2 points reflect two risk factors, with an 81% success rate; 3 points signify three risk factors with a 63% success rate; 4 points relate to an 11% success rate; and 5 points indicate a 0% success rate. The health indicators incorporated into the formula for this score are easily measurable with standard medical equipment, rendering the risk-scoring method practical and accessible for most hospitals.

“We propose a score model that can accurately predict successful weaning from MCS in patients with cardiogenic shock,” said Clinical Fellow Sho Suzuki who led the research team. “Interestingly, this score can be used to make bedside predictions about weaning, considering advanced therapy, or withdrawing the patient from care. We are looking forward to further research on such non-invasive methods for weaning patients and hope to establish a prediction model that successfully predicts weaning without the need for hemodynamic assessments.”

Related Links:
Shinshu University School of Medicine

Gold Member
Real-Time Diagnostics Onscreen Viewer
GEMweb Live
Gold Member
POC Blood Gas Analyzer
Stat Profile Prime Plus
New
Standing Sling
Sara Flex
New
Infant Phototherapy Unit
TRP100

Print article

Channels

Surgical Techniques

view channel
Image: In appropriate patients, cure rates for testicular cancer are excellent with open surgery (Photo courtesy of IU School of Medicine)

Traditional Open Surgery for Lymph Node Removal Remains Gold Standard for Testicular Cancer

Testicular cancer is significantly less common than breast or prostate cancer but remains the most prevalent solid tumor in males aged 15 to 35. For the right patients, the cure rates for this type of... Read more

Patient Care

view channel
Image: The portable biosensor platform uses printed electrochemical sensors for the rapid, selective detection of Staphylococcus aureus (Photo courtesy of AIMPLAS)

Portable Biosensor Platform to Reduce Hospital-Acquired Infections

Approximately 4 million patients in the European Union acquire healthcare-associated infections (HAIs) or nosocomial infections each year, with around 37,000 deaths directly resulting from these infections,... Read more

Health IT

view channel
Image: First ever institution-specific model provides significant performance advantage over current population-derived models (Photo courtesy of Mount Sinai)

Machine Learning Model Improves Mortality Risk Prediction for Cardiac Surgery Patients

Machine learning algorithms have been deployed to create predictive models in various medical fields, with some demonstrating improved outcomes compared to their standard-of-care counterparts.... Read more

Point of Care

view channel
Image: The acoustic pipette uses sound waves to test for biomarkers in blood (Photo courtesy of Patrick Campbell/CU Boulder)

Handheld, Sound-Based Diagnostic System Delivers Bedside Blood Test Results in An Hour

Patients who go to a doctor for a blood test often have to contend with a needle and syringe, followed by a long wait—sometimes hours or even days—for lab results. Scientists have been working hard to... Read more
Copyright © 2000-2024 Globetech Media. All rights reserved.