Cardiac Anesthesia Risk Evaluation Score (CARE)

CARE Score
Patient Medical Status
Surgical Complexity
Emergency Surgery
CARE Score: –
Awaiting input
Select all three criteria.
Predicts mortality and morbidity after cardiac surgery.

Why Use

The score contains only 6 variables (compared to EuroSCORE, which contains 18 variables) but shows similar accuracy. Quickly risk-stratifies patients undergoing cardiac surgery in the clinical setting. Requires fewer variables and data, including those that may be hard to obtain on the day of surgery.

When to Use

Patients undergoing cardiac surgery.

Formula

Morbidity was defined as any of the following ( Dupuis 2001 ): Cardiovascular : low cardiac output, hypotension, or both treated with intraaortic balloon pump, with two or more intravenous inotropes or vasopressors for more than 24 h, or with both, malignant arrhythmia (asystole and ventricular tachycardia or fibrillation) requiring cardiopulmonary resuscitation, antiarrhythmia therapy, or automatic cardiodefibrillator implantation Respiratory : mechanical ventilation for more than 48 h, tracheostomy, reintubation Neurologic : focal brain injury with permanent functional deficit, irreversible encephalopathy Renal : acute renal failure requiring dialysis Infectious : septic shock with positive blood cultures, deep sternal or leg wound infection requiring intravenous antibiotics, surgical debridement, or both Other : any surgery or invasive procedure necessary to treat a postoperative adverse event associated with the initial cardiac surgery Examples of complex surgery ( Dupuis 2001 ): Reoperation Combined valve and coronary artery surgery Multiple valve surgery Left ventricular aneurysmectomy Repair of VSD after MI CABG of diffuse or heavily calcified vessels Other, as judged by clinicians

Pearls / Pitfalls

The Cardiac Anesthesia Risk Evaluation (CARE) Score was created to develop a simple risk classification tool to predict mortality and morbidity after cardiac surgery. Shows similar accuracy to more complex cardiac anesthesia risk assessment schematics. Does not account for age and left ventricular (LV) function.

Advice

Patients with a CARE score of 3 or above NOT undergoing emergent surgery should be optimized (after weighing the risks and benefits of delaying surgery), and if their uncontrolled medical problems can be treated preoperatively, mortality and morbidity outcomes may decrease dramatically. Patients with CARE scores above 3 should be informed preoperatively of their surgical risk. Predictive models such as the CARE score have modest predictive abilities and should be utilized as a tool used in conjunction with other clinical factors.

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