Characteristics and outcomes in extracorporeal membrane oxygenation support in COVID-19 patients: A nationwide cohort-study in Argentina

Lockhart, Carolina; García, Christian A Casabella; Heras, Marcos Las; Matarrese, Agustín; Espinosa, Lucio F.; Norese, Mariano; Ivulich, Daniel; Bisso, Indalecio Carboni; Pálizas, Fernando

doi:10.1016/j.acci.2022.10.001

Cited by 1 publication

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“…Broman et al reported 30 that survival in COVID‐19 ECMO patients was 53% (770) in the first wave and 44% (677; p < 0.0001) in the second wave 31 ; also Lockhart et al informed a 57% ECMO survival rate in Argentina 32 . Therefore, to avoid futility, predictable complications, and therapeutic obstinacy, the decision to start ECMO should rely on the best available evidence (Table 3).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the discrimination and calibration of predictive scores of mortality in ECMO for patients with COVID‐19

et al. 2023

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Background The criteria for the selection of COVID‐19 patients that could benefit most from ECMO organ support are yet to be defined. In this study, we evaluated the predictive performance of ECMO mortality predictive models in patients with COVID‐19. We also performed a cost–benefit analysis depending on the mortality predicted probability. We conducted a retrospective cohort study in COVID‐19 patients who received ECMO at two tertiary care hospitals between March 2020 to July 2021. Materials and Methods We evaluated the discrimination (C‐statistic), calibration (Cox calibration), and accuracy of the prediction of death due to severe ARDS in V‐V ECMO score (PRESERVE), the Respiratory Extracorporeal Membrane Oxygenation Survival Score (RESP) score, and the PREdiction of Survival on ECMO Therapy‐Score (PRESET) score. In addition, we compared the RESP score with Plateau pressure instead of Peak pressure. Results We included a total of 36 patients, 29 (80%) of them male and with a median (IQR) APACHE of 10 (8–15). The PRESET score had the highest discrimination (AUROCs 0.81 [95%CI 0.67–0.94]) and calibration (calibration‐in‐the‐large 0.5 [95%CI −1.4 to 0.3]; calibration slope 2.2 [95%CI 0.7/3.7]). The RESP score with Plateau pressure had higher discrimination than the conventional RESP score. The cost per QALY in the USA, adjusted to life expectancy, was higher than USD 100 000 in patients older than 45 years with a PRESET > 10. Conclusion The PRESET score had the highest predictive performance and could help in the selection of patients that benefit most from this resource‐demanding and highly invasive organ support.

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Section: Discussionmentioning

confidence: 99%