Photo Credit: Mohammed Haneefa Nizamudeen

The following is a summary of “Evaluation of HACOR scale as a predictor of non-invasive ventilation failure in acute cardiogenic pulmonary oedema patients: A prospective observational study,” published in the May 2024 issue of Emergency Medicine by Chong, et al.

For a study, researchers sought to assess the effectiveness of the HACOR scale in predicting NIV failure among patients with acute cardiogenic pulmonary edema (ACPO) admitted to the emergency department (ED).

A prospective, observational study was conducted involving consecutive patients with ACPO requiring non-invasive ventilation (NIV) in the ED. The primary outcome measure was the ability of the HACOR score to predict NIV failure. Data on clinical, physiological, and HACOR score parameters were collected at baseline and 1 h, 12 h, and 24 h after NIV initiation.

Of the 221 patients included in the analysis, 54 (24.4%) experienced NIV failure. The optimal HACOR score (>5) at 1 h after NIV initiation predicted NIV failure with acceptable accuracy (AUC 0.73, sensitivity 53.7%, specificity 83.2%). However, respiratory and heart rates were not significant predictors among the components of the HACOR score. Other important predictors of NIV failure included acute coronary syndrome, acute kidney injury, the presence of congestive heart failure as a comorbidity, and the ROX index.

The HACOR scale, measured 1 h after NIV initiation, demonstrated predictive value in identifying NIV failure among patients with ACPO. A cut-off level > 5 could serve as a valuable clinical decision-support tool in the population. Nonetheless, clinicians should consider additional factors such as acute coronary and kidney diagnoses, congestive heart failure comorbidity, and the ROX index when making decisions regarding invasive mechanical ventilation.

Reference: sciencedirect.com/science/article/abs/pii/S0735675724000597