cardiology anaesthesia-icu

SAVE Score for Survival After Veno-Arterial ECMO (VA-ECMO)

SAVE score (Schmidt 2015): pre-ECMO prediction of in-hospital survival for adults receiving veno-arterial ECMO for refractory cardiogenic shock.

Diagnosis: acute myocarditis (+3)

Yes

Diagnosis: refractory VT/VF (+2)

Yes

Diagnosis: post heart or lung transplantation (+3)

Yes

Diagnosis: congenital heart disease (−3)

Yes

Age*

Weight*

Acute pre-ECMO liver failure (bilirubin ≥ 33 µmol/L or ALT/AST > 70 IU/L)*

Acute pre-ECMO CNS dysfunction (neurotrauma, stroke, encephalopathy, cerebral embolism, seizures)*

Acute pre-ECMO renal failure (e.g. creatinine > 133 µmol/L, with or without RRT)*

Chronic renal failure (kidney damage or eGFR < 60 mL/min/1.73 m² for ≥ 3 months)*

Intubation before ECMO*

Peak inspiratory pressure ≤ 20 cmH₂O*

Cardiac arrest before ECMO*

Diastolic BP before ECMO ≥ 40 mmHg (worst value in the 6 hours before cannulation)*

Pulse pressure before ECMO ≤ 20 mmHg (worst value in the 6 hours before cannulation)*

HCO₃ before ECMO ≤ 15 mmol/L*

Score interpretation

SAVE Class I — In-Hospital Survival ~75% 6–17

SAVE score > 5 (risk class I).

→ VA-ECMO appropriate where indicated; daily reassessment for recovery, bridge to decision or weaning.

SAVE Class II — In-Hospital Survival ~58% 1–5

SAVE score 1 to 5 (risk class II).

→ VA-ECMO appropriate where indicated; discuss realistic prognosis with the family; treat reversible causes.

SAVE Class III — In-Hospital Survival ~42% -4–0

SAVE score −4 to 0 (risk class III).

→ Multidisciplinary decision; consider a time-limited trial with explicit goals and early palliative care input.

SAVE Class IV — In-Hospital Survival ~30% -9–-5

SAVE score −9 to −5 (risk class IV).

→ Multidisciplinary decision on appropriateness; time-limited trial with documented withdrawal criteria if started.

SAVE Class V — In-Hospital Survival ~18% -35–-10

SAVE score ≤ −10 (risk class V).

→ Benefit of ECMO doubtful; senior shared decision-making with the family; comfort-focused care if ECMO is not pursued.

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.

Curated clinical cross-links plus same-class fallbacks.

Calculators

SEX-SHOCK Risk Score for Cardiogenic Shock Development in ACS · Cardiogenic Shock

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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