SAVE Score for Survival After Veno-Arterial ECMO (VA-ECMO)
Validated pre-ECMO score predicting in-hospital survival for patients requiring veno-arterial ECMO for refractory cardiogenic shock. Helps guide patient selection and family counselling.
Score interpretation
SAVE score > 5 -- approximately 75% in-hospital survival on VA-ECMO
→ Proceed with VA-ECMO; optimise ECMO circuit (flows 2.4-3.0 L/min/m2, target MAP > 65 mmHg); weaning assessment at 48-72 hours; daily echo (LV ejection, aortic valve opening); target native cardiac recovery; bridge to decision for durable MCS or transplant if no recovery; anticoagulation: heparin UFH targeting ACT 180-200 seconds; monitor daily: ABG, lactate, LFTs, platelet count (HIT risk); early physiotherapy; family communication with optimistic prognosis.
SAVE score 1-5 -- approximately 58% in-hospital survival; active treatment appropriate
→ VA-ECMO appropriate; discuss realistic prognosis with family; aggressive management of reversible causes (PCI for MI, immunosuppression for myocarditis -- dexamethasone, IVIG); daily ICU assessment; LV unloading if LVAD/IABP needed (LVAD-ECMO configuration or Impella-ECMO); daily weaning trials from 48 hours; palliative care early involvement for contingency planning; transplant team contact if age and profile suitable; document daily goals of care.
SAVE score -8 to 0 -- 30-42% survival; high-risk; consider goals of care
→ Multidisciplinary team discussion before ECMO or at day 1; frank family discussion about prognosis and goals; time-limited ECMO trial (3-5 days) with clear endpoints: LV function recovery, bridge to LVAD/transplant, or comfort care; criteria for ECMO withdrawal: progressive multi-organ failure, neurological catastrophe, no cardiac recovery and not eligible for durable MCS or transplant; palliative care team involvement; spiritual support; if proceeding: maximum ECMO support with clear reassessment criteria; document all decisions.
SAVE score <= -9 -- approximately 18% survival; highest risk; ECMO benefit questionable
→ Urgent ethics/team discussion regarding appropriateness of ECMO; shared decision-making with next of kin/legal guardian; if ECMO initiated: 24-48 hour time-limited trial with explicit withdrawal criteria documented at outset; consider de novo goals of care and comfort-focused pathway if ECMO not in patient or family preference; intensive palliative support; avoid futile escalation; legal considerations: best interests, advance directives; hospice/inpatient palliative care; family bereavement support.
Interpretation bands for the SAVE Score VA-ECMO. Apply clinical judgement and local guidance.
References
- Schmidt M et al. Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J. 2015;36(33):2246-2256.
- Combes A et al. Extracorporeal membrane oxygenation for severe acute respiratory failure in adults. JAMA. 2018;319(8):777-791.
Related
Curated clinical cross-links plus same-class fallbacks.
- Noradrenaline (Cardiogenic Shock / Vasopressor) · Vasopressor / Cardiogenic Shock
- Hydrocortisone (ICU — Stress Dosing) · Corticosteroid (ICU/Septic Shock)
- Ranolazine · Refractory Stable Angina
- Selexipag · Pulmonary Arterial Hypertension
- Macitentan · Pulmonary Arterial Hypertension
- Folinic Acid (Calcium Folinate / Leucovorin) · Antidote / Chemotherapy Support
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.