SAVE (Survival after Veno-Arterial ECMO) Score

SAVE Score Calculator

Diagnosis Group

Age

Weight (kg)

Acute Liver Failure

Acute CNS Dysfunction

Acute Renal Failure

Chronic Renal Failure

Mechanical Ventilation Pre-ECMO

Cardiac Arrest Pre-ECMO

Diastolic BP Before ECMO

Pulse Pressure ≤ 20 mmHg

Bicarbonate ≤ 15 mEq/L

Peak Inspiratory Pressure ≥ 20 cmH2O

Intubation Duration > 10.7 Hours

Total SAVE Score: –

Score: 0

Select all criteria. Default scoring assumes 0 for un-set fields.

Predicts in-hospital survival in adult patients after VA ECMO for refractory cardiogenic shock.

Why Use

ECMO is a resource-intensive endeavor with high morbidity, and patients should be selected carefully. Survival estimates may aid the decision process.

When to Use

Patients with refractory cardiogenic shock in whom veno-arterial (VA) ECMO is being considered. Do not use in patients receiving veno-venous (VV) ECMO (see RESP Score ).

Formula

SAVE Score = addition of the selected points (below) minus 6 Variable Points Age, years 18-38 7 39-52 4 53-62 3 ≥63 0 Weight <65 kg (<143.3 lbs) 1 65-89 kg (143.3-196.2 lbs) 2 >89 kg (>196.2 lbs) 0 Etiology of cardiogenic shock* Myocarditis 3 Refractory VT/VF 2 Post heart or lung transplantation 3 Congenital heart disease -3 Renal Acute renal failure (defined as acute renal insufficiency (e.g. creatinine >1.5 mg/dL (132.6 µmol/L) with or without RRT) -3 Chronic renal failure (defined as either kidney damage or GFR <60 mL/min/1.73 m² for ≥3 months) -6 HCO₃ before ECMO ≤15 mmol/L (91.5 mg/dL) (worst value within 6 hrs before ECMO cannulation) -3 Respiratory Duration of intubation prior to initiation of ECMO, hrs ≤10 0 11-29 -2 ≥30 -4 Peak inspiratory pressure ≤20 cm H₂O (≤2.0 kPa) 3 Cardiac Pre-ECMO cardiac arrest -2 Diastolic blood pressure before ECMO ≥40 mmHg (worst value within 6 hrs before ECMO cannulation) 3 Pulse pressure before ECMO ≤20 mmHg (worst value within 6 hrs before ECMO cannulation) -2 Other organ failures pre-ECMO Liver failure (defined as bilirubin ≥33 µmol/L (1.9 mg/dL) or elevation of serum aminotransferases (ALT or AST) >70 UI/L) -3 CNS dysfunction (includes combined neurotrauma, stroke, encephalopathy, cerebral embolism, seizure/epileptic syndromes) -3 *If any other cause of cardiogenic shock, no points are added.

Pearls / Pitfalls

Only predicts survival to hospital discharge and does not predict neurologic function or functional status, which may be important considerations. The score was derived from a cohort of patients who were placed on VA ECMO, and likely excluded many patients who may have had different survival rates. Patients receiving CPR during cannulation (eCPR) were not included in the derivation of the SAVE Score; therefore, the score may not apply to these patients.

Management

We are not aware of any guidelines that incorporate the SAVE Score, but survival prediction may be incorporated into the decision to initiate VA ECMO.

Critical Actions

Comprehensive decision-making should not be based solely on one prediction rule, and the threshold to initiate ECMO may vary by institution.

Advice

Other factors may contribute to the decision to initiate ECMO (e.g. life expectancy, quality of life, resource availability).

More Information

Interpretation: SAVE Score Risk class In-hospital survival >5 I 75% 1 to 5 II 58% -4 to 0 III 42% -9 to -5 IV 30% ≤-10 V 18%