External validation of scores proposed for estimation of survival probability of patients with severe adult respiratory distress syndrome undergoing extracorporeal membrane oxygenation therapy: a retrospective study

Abstract

IntroductionThis study was designed as an external validation of the recently proposed Predicting Death for Severe ARDS on V-V ECMO (PRESERVE) score, The respiratory extracorporeal membrane oxygenation survival prediction (RESP) score and a scoring system developed for externally retrieved patients on extracorporeal membrane oxygenation (ECMO) at our institution. All scores are proposed for the estimation of survival probability after ECMO treatment for severe adult respiratory distress syndrome.MethodsData from 51 patients (2008 to 2013) were analyzed in this retrospective single-center study. A calculation of an adapted PRESERVE score, the RESP score as well as the score developed for externally retrieved ECMO patients was performed.ResultsSeventy one percent of patients received veno-venous (v-v) and 29% venous-arterial (v-a) ECMO support during the study period. Overall survival at 6 months was 55%, with a 61% survival rate for v-v cannulated patients and a 40% survival rate for v-a cannulated patients. The PRESERVE score discriminated survivors and non-survivors with an area under the curve of 0.67 (95% CI 0.52 to 0.82, P = 0.03). Analyzing survival prediction according to cannulation modus, the PRESERVE score and the RESP score significantly predicted survival for patients on v-v ECMO with an area under the curve of 0.75 (95% CI 0.57 to 0.92, P = 0.01) and 0.81 (95% CI 0.67 to 0.95, P = 0.035), respectively, while the scoring system developed for externally retrieved ECMO patients failed to predict survival in our study population. All scores failed to predict mortality for patients on v-a ECMO.ConclusionOur single-center validation confirms that the proposed PRESERVE and RESP score predict survival for patients treated with v-v ECMO for severe adult respiratory distress syndrome.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0875-z) contains supplementary material, which is available to authorized users.

Advanced Age as a Predictor of Survival and Weaning in Venoarterial Extracorporeal Oxygenation: A Retrospective Observational Study

“…Klinzing et al [53, 54] demonstrated that the PRESERVE and RESP scoring systems fail to predict mortality for patients receiving VA ECMO. The EuroSCORE was designed to predict the mortality of patients undergoing cardiac surgery and may correlate with the outcomes of postcardiotomy failure patients.…”

Neutrophil expression of glucocorticoid-induced leucine zipper (GILZ) anti-inflammatory protein is associated with acute respiratory distress syndrome severity

“…Moreover, patients receiving ECMO had higher gilz expression than patients without ECMO. This rescue therapy is used in severe ARDS when conventional mechanical ventilation fails [5, 38]. As ECMO has been shown to have pro-inflammatory effects in vivo [39, 40], it is conceivable that GILZ induction was aimed at compensating for these effects.…”

“…Despite significant research, ARDS management still consists mainly of supportive care, based on optimized ventilation and extracorporeal membrane oxygenation (ECMO) [5]. New therapeutic strategies based on modulation of inflammation, using mesenchymal stromal cells, miRNA, or regulatory T cells, have recently been proposed [6–8].…”

Mathematical modeling of extracorporeal CO2 removal therapy

“…Acute Respiratory Distress Syndrome (ARDS) is still life threatening despite new strategies in mechanical ventilations [28,18,8]. Mortality and morbidity of chronic obstructive pulmonary disease (COPD) are also considerable [34,7].…”