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Overview :
The Cardiac Anesthesia Risk Evaluation Scale (CARE Score) is
a simple risk classification system for patients undergoing cardiac surgery.
This can rapidly stratify a patient for the probability of morbidity and
mortality. The authors are from the University of Ottawa Heart Institute in
Canada.
Parameters:
(1) cardiac disease status
(2) medical disease status
(3) cardiac surgery planned
(4) urgency of surgery
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Parameter
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Status
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Group
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cardiac disease
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stable
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A1
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uncontrolled
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A2
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advanced (end stage)
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A3
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medical diseases
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none
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B1
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1 or more controlled
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B2
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1 or more uncontrolled
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B3
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cardiac surgery
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noncomplex
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C1
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complex
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C2
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undertaken as last hope to save or improve life
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C3
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urgency of surgery
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not emergency
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D1
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emergency (surgery performed as soon as diagnosis is made
and an OR is available)
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D2
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Controlled medical problems include:
• controlled hypertension
• controlled diabetes mellitus
• controlled peripheral vascular disease
• controlled chronic obstructive pulmonary disease
• controlled systemic disease
Uncontrolled cardiac or medical problems include:
• unstable angina pectoris treated with intravenous heparin
or nitroglycerin
• preoperative intra-aortic balloon pump
• heart failure with pulmonary or peripheral edema
• uncontrolled hypertension
• renal insufficiency (serum creatinine > 140µmol/L
• other debilitating systemic disease
Complex surgery includes:
• reoperation
• combined valve and coronary artery surgery
• multiple valve surgery
• left ventricular aneurysmectomy
• repair of ventricular septal defect (VSD) after myocardial
infarction
• coronary artery bypass of diffuse or heavily calcified
vessels
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Situation
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Score
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Risk Category
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A1 AND B1 AND C1
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1
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1
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A1 AND B2 AND C1
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2
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2
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(A2 OR B3 OR C2) AND D1
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3
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3
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(A2 OR B3 OR C2) AND D2
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3E
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4
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(A2 OR A3 OR B3) AND C2 AND D1
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4
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5
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(A2 OR A3 OR B3) AND C2 AND D2
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4E
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6
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A3 AND C3 AND D1
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5
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7
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A3 AND C3 AND D2
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5E
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8
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Risk Category
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Morbidity
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Prolonged Length of Stay
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Mortality
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1
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5.4% (4.3-6.8)
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2.9% (2.2-3.9)
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0.5% (0.3-0.9)
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2
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10.3% (8.9-12.1)
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5.1% (4.2-6.3)
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1.1% (0.7-1.7)
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3
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19% (17.2-20.9)
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8.8% (7.6-10.2)
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2.2% (1.6-3.1)
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4
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32.1% (29.3-35.0)
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14.7% (12.8-16.8)
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4.5% (3.5-5.7)
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5
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48.8% (44.1-53.6)
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23.5% (20.1-27.3)
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8.8% (6.9-11.3)
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6
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65.8% (59.5-71.6)
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35.4% (29.3-42.0)
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16.7% (12.4-22.1)
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7
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79.6% (73.2-84.7)
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49.4% (40.4-58.5)
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29.3% (20.8-39.6)
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8
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88.7% (83.5-92.5)
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63.6% (52.5-73.4)
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46.2% (32.4-60.5)
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after Table 4, page 200
Performance:
• predicted
morbidity Area Under Curve by ROC Analysis: 0.721 +/- 0.014
• predicted
mortality Area Under Curve by ROC Analysis: 0.801 +/- 0.027
• These values
compared favorably to the Parsonnet, Tu and Truman scores (see Chapter 6 on
Cardiology).
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