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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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Abstract

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.

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Authors and Affiliations

  1. Department of Acute and Emergency Medicine, Elisabeth-Hospital Essen, Essen, Germany

    Ingo Voigt, Marco Mighali, Daniela Manda & Phillip Aurich

  2. Department of Cardiology and Angiology, Elisabeth-Hospital Essen, Essen, Germany

    Phillip Aurich & Oliver Bruder

  3. Ruhr-University, Bochum, Germany

    Ingo Voigt & Oliver Bruder

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IV: Conceptualization, methodology, investigation, writing—original draft, writing—review and editing, visualization. MM, DM, PA: Investigation, writing—review and editing. OB: Writing—review and editing, supervision.

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Correspondence to Ingo Voigt.

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Ethical approval was waived by the Ethics Committee of the regional Medical Association (North-Rhine; Nr.20210506) in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Voigt, I., Mighali, M., Manda, D. et al. 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. Intern Emerg Med 17, 1463–1470 (2022). https://doi.org/10.1007/s11739-022-02937-7

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