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    Cardiac Anesthesia Risk Evaluation Score (CARE)

    Predicts mortality and morbidity after cardiac surgery.
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    When to Use
    Pearls/Pitfalls
    Why Use
    • Patients undergoing cardiac surgery.
    • The Cardiac Anesthesia Risk Evaluation (CARE) Score was created to develop a simple risk classification tool to predict mortality and morbidity after cardiac surgery.
    • Shows similar accuracy to more complex cardiac anesthesia risk assessment schematics.
    • Does not account for age and left ventricular (LV) function.
    • The score contains only 6 variables (compared to EuroSCORE, which contains 18 variables) but shows similar accuracy.
    • Quickly risk-stratifies patients undergoing cardiac surgery in the clinical setting.
    • Requires fewer variables and data, including those that may be hard to obtain on the day of surgery.
    About the Creator
    Jean-Yves Dupuis, MD
    Content Contributors
    • Amit Patel, MD

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • Patients with a CARE score of 3 or above NOT undergoing emergent surgery should be optimized (after weighing the risks and benefits of delaying surgery), and if their uncontrolled medical problems can be treated preoperatively, mortality and morbidity outcomes may decrease dramatically.
    • Patients with CARE scores above 3 should be informed preoperatively of their surgical risk.
    • Predictive models such as the CARE score have modest predictive abilities and should be utilized as a tool used in conjunction with other clinical factors.

    Formula

    Morbidity was defined as any of the following (Dupuis 2001):

    1. Cardiovascular: low cardiac output, hypotension, or both treated with intraaortic balloon pump, with two or more intravenous inotropes or vasopressors for more than 24 h, or with both, malignant arrhythmia (asystole and ventricular tachycardia or fibrillation) requiring cardiopulmonary resuscitation, antiarrhythmia therapy, or automatic cardiodefibrillator implantation
    2. Respiratory: mechanical ventilation for more than 48 h, tracheostomy, reintubation
    3. Neurologic: focal brain injury with permanent functional deficit, irreversible encephalopathy
    4. Renal: acute renal failure requiring dialysis
    5. Infectious: septic shock with positive blood cultures, deep sternal or leg wound infection requiring intravenous antibiotics, surgical debridement, or both
    6. Other: any surgery or invasive procedure necessary to treat a postoperative adverse event associated with the initial cardiac surgery

    Examples of complex surgery (Dupuis 2001):

    • Reoperation
    • Combined valve and coronary artery surgery
    • Multiple valve surgery
    • Left ventricular aneurysmectomy
    • Repair of VSD after MI
    • CABG of diffuse or heavily calcified vessels
    • Other, as judged by clinicians

    Facts & Figures

    Evidence Appraisal

    When compared to other multivariate studies, the CARE score showed equivalent sensitivity/specificity tradeoff (by receiver operator curve analysis) when compared to more complex cardiac anesthesia risk assessment schematics (developed by Parsonnet, Tuman, and Tu, respectively).

    From Dupuis 2001.

    When compared with the often utilized EuroSCORE, the CARE score provides reliable risk adjusted mortality results with 6 clinical variables versus the 17 in the EuroSCORE (Tran et al). 

    Literature

    Other References

    Research PaperTran DT et al. Comparison of the EuroSCORE and Cardiac Anesthesia Risk Evaluation (CARE) score for risk-adjusted mortality analysis in cardiac surgery. European Journal of Cardio-Thoracic Surgery 41.2 (2012): 307-313.Research PaperDupuis JY, Tran DT, and McDonald B. 488: Cardiac Anesthesia Risk Evaluation (care) Score Versus Euroscore for Morbidity Prediction in The Intensive Care Unit After Cardiac Surgery. Critical Care Medicine 39.12 (2011): 135.Research PaperParsonnet V, Dean D, Bernstein AD. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation. 1989;79:I3–12.Research PaperTuman KJ, McCarthy RJ, March RJ, Najafi H, Ivanikovich AD. Morbidity and duration of ICU stay after cardiac surgery: a model of preoperative risk assesment. Chest. 1992; 102 (1): 36-44.Research PaperTu JV, Jaglal SB, Naylor D, the Steering Committee of the Provincial Adult Care Network of Ontario: Multicenter validation of a risk index for mortality, intensive care unit stay, and overall hospital length of stay after cardiac surgery. Circulation 1995; 91: 677–84
    Jean-Yves Dupuis, MD

    About the Creator

    Jean-Yves Dupuis, MD, is a staff anesthesiologist of the Division of Cardiac Anesthesiology and an associate professor at the University of Ottawa. He is a regular contributor as a principal or co-investigator to single and multicenter randomized trials assessing new drugs and therapies in the perioperative setting of cardiac surgery. Dr. Dupuis’ research interests are perioperative epidemiology and the analysis of medical practice in the cardiac surgical population.

    To view Jean-Yves Dupuis, MD's publications, visit PubMed

    Content Contributors
    • Amit Patel, MD