Objectives
ECMO support for pediatric refractory cardiogenic shock is associated with high mortality and poses significant clinical challenges. Leveraging data from the Chinese Pediatric Extracorporeal Life Support (CP-ECLS) Registry, this study established a predictive model to identify early warning factors for in-hospital mortality and assist clinical decision-making.
Methods
This multicenter retrospective study utilized data from the CP-ECLS Registry to analyze children receiving VA-ECMO for RCS between January 2017 and December 2023. Multivariate Cox regression identified early warning factors for in-hospital mortality, while a prognostic model equation by integrating the weighted contributions of risk factors. A time-dependent risk stratification assessment tool: Pediatric ECMO Cardiogenic Shock Outcome Score（PECSOS）was developed to visualize the prognostic model for clinical application.
Results
A total of 1,113 eligible children receiving ECMO between 2017-2023 were identified from the CP-ECLS registry, with 666 (59%) surviving to discharge.Through integration of Cox regression analysis and variable importance ranking to develop a model equation. A risk score cutoff of 1.74 was selected in the model equation to stratify the dataset into high-risk and low-risk groups for in-hospital mortality. Total dataset underwent stratified random sampling (6:4 ratio) yielding into training set and test set. The prognostic model developed on the training set demonstrated satisfactory performance upon external validation in the test cohort (Training set: days 3, 7, and 14 were 0.816, 0.807, and 0.800; Test set: days 3, 7, and 14 were 0.797, 0.766, and 0.759). To enhance clinical utility, we developed the PECSOS (Pediatric ECMO-Cardiogenic Shock Outcome Stratification) risk stratification schema. The high-risk cohort necessitates intensified hemodynamic monitoring and aggressive therapeutic escalation to mitigate adverse outcomes.
Conclusion
The risk stratification model and PECSOS in this study demonstrate potential to optimize clinical decision-making for pediatric RCS requiring ECMO support, with implications for improving prognosis and enhancing healthcare resource allocation efficiency.
Keywords: pediatric refractory cardiogenic shock, ECMO, in-hospital mortality, risk stratification
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