Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The SAVE score calculator assesses the likelihood of survival following veno-arterial extracorporeal membrane oxygenation (VA-ECMO) based on various clinical parameters. The calculator requires user inputs on specific conditions and characteristics of the patient, assigns a numerical score to each input, calculates a total score, and then interprets this score in terms of expected in-hospital survival rates. 

The inputs include patient age, weight, etiology of cardiogenic shock, acute and chronic renal failure status, HCO₃ levels before ECMO, duration of intubation before ECMO, peak inspiratory pressure, pre-ECMO cardiac arrest occurrence, diastolic blood pressure status, pulse pressure before ECMO, liver failure, and CNS dysfunction. Each input corresponds to an ordinal category with a predefined score. The table below delineates the scoring criteria:

| Parameter | Options | Score |
|-----------|---------|-------|
| Age, years | 18-38 | 7 |
| | 39-52 | 4 |
| | 53-62 | 3 |
| | >= 63 | 0 |
| Weight | <= 65 kg | 1 |
| | 65-89 kg | 2 |
| | >= 90 kg | 0 |
| Etiology of cardiogenic shock | Myocarditis | 3 |
| | Refractory VT/VF | 2 |
| | Post heart or lung transplantation | 3 |
| | Congenital heart disease | 3 |
| | Other diagnosis requiring VA-ECMO | 0 |
| Acute renal failure | Yes | 3 |
| | No | 0 |
| Chronic renal failure | Yes | 6 |
| | No | 0 |
| HCO₃ before ECMO <= 15 mmol/L [91.5 mg/dL] | Yes | 3 |
| | No | 0 |
| Duration of intubation before ECMO, hours | <= 10 | 0 |
| | 11-29 | 2 |
| | >= 30 | 4 |
| Peak inspiratory pressure <= 20 cmH₂O | Yes | 3 |
| | No | 0 |
| Pre-ECMO cardiac arrest | Yes | 2 |
| | No | 0 |
| Diastolic blood pressure before ECMO >= 40 mmHg | Yes | 3 |
| | No | 0 |
| Pulse pressure before ECMO <= 20 mmHg | Yes | 2 |
| | No | 0 |
| Liver failure | Yes | 3 |
| | No | 0 |
| CNS dysfunction | Yes | 3 |
| | No | 0 |

The total score is obtained by summing the scores associated with each input according to the above table. Based on the total score, the calculator interprets the in-hospital survival probability as follows:

- A score of less than or equal to -10 indicates Class V, with an 18% survival rate.
- A score between -9 and -5 indicates Class IV, with a 30% survival rate.
- A score between -4 and 0 indicates Class III, with a 42% survival rate.
- A score between 1 and 5 indicates Class II, with a 58% survival rate.
- A score greater than 5 indicates Class I, with a 75% survival rate.

The Survival After Veno-Arterial Extracorporeal Membrane Oxygenation (SAVE) Score is a clinical calculator used in the management of patients undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO). This score is used to predict the survival rates of patients after VA-ECMO, which is a life-support treatment that pumps and oxygenates a patient's blood outside the body, allowing the heart and lungs to rest.

The SAVE Score is applicable to adult patients who are undergoing VA-ECMO for cardiogenic shock or cardiac arrest. It is particularly useful in helping clinicians to make informed decisions about the initiation of VA-ECMO, and to provide a prognosis to patients and their families.

The score takes into account several variables including age, sex, body mass index, pre-ECMO factors like mechanical ventilation, CPR, and the presence of certain comorbidities, as well as post-ECMO factors like renal replacement therapy and neurological complications.

The SAVE Score should not be used in pediatric patients, or in patients undergoing veno-venous ECMO for respiratory failure, as it has not been validated in these populations.

Survival after veno-arterial-extracorporeal membrane oxygenation score (SAVE score)

In the context of assessing circulatory health, the Mean Arterial Pressure (MAP) calculator is a tool that processes two main inputs: systolic and diastolic blood pressures. These inputs are measured in millimeters of mercury (mmHg), adhering to certain acceptable ranges for accuracy and safety—systolic values between 60 and 300 mmHg and diastolic values from 20 to 180 mmHg.

The calculation of MAP provides a crucial insight into the perfusion pressure experienced by vital organs, relying on a straightforward formula: 

MAP = diastolic blood pressure + one-third of the pulse pressure (where pulse pressure is the difference between systolic and diastolic pressures).

This equation highlights that diastolic pressure, representing the longer-lasting phase of the cardiac cycle, exerts more influence in the calculation than systolic pressure. The resultant MAP, expressed in mmHg and ranging logically from 0 to 200 mmHg, signifies the average driving force of blood through the systemic circulation in a single cardiac cycle.

Understanding MAP values is essential in clinical environments:
- A MAP between 70 and 100 mmHg is typically ideal, suggesting optimal organ perfusion.
- MAP values falling below 60 mmHg may indicate potential risk for organ under-perfusion, a critical concern in intensive care settings.
- MAP exceeding 100 mmHg often points toward possible hypertension or other cardiovascular anomalies, necessitating further evaluation.

This calculated MAP value provides invaluable information used widely in clinical practice for observing and managing patients' blood pressure, aiding in the maintenance of proper organ function and overall cardiovascular health.

MAP calculates average arterial pressure during a cardiac cycle using systolic and diastolic blood pressure.

Mean Arterial Pressure (MAP)

Cardiogenic shock

Mechanical circulatory support

Intra-aortic balloon counterpulsation

Pulmonary artery catheterization

Inotropes

Setting of care

Vasopressors

Critical care ultrasound

As per ACC/ACEP/AHA/…/SCAI 2025 guidelines, 

Coronary artery revascularization

Fibrinolytic therapy

Fluid resuscitation

The updated American College of Cardiology (ACC) and American Heart Association (AHA) guidelines for acute coronary syndromes (ACS) provide recommendations for the management of cardiogenic shock in ACS.

Emergency revascularization of the culprit lesion by PCI or CABG is recommended regardless of time from symptom onset, but routine PCI of a non-infarct-related artery should not be performed due to an increased risk of renal failure and death. Short-term mechanical circulatory support devices are suggested for hemodynamic stabilization as a bridge to surgery.

Based on the DanGer-SHOCK trial, a microaxial intravascular flow pump is now suggested for selected patients with STEMI and severe or refractory cardiogenic shock. Routine use of intra-aortic balloon pump and venoarterial extracorporeal membrane oxygenation is not recommended due to a lack of survival benefit.


Cardiogenic shock

Guidelines

Key sources

Diagnostic investigations

Diagnostic procedures

Medical management

Therapeutic procedures