Predicting Survival After Extracorporeal Membrane Oxygenation for ARDS: An External Validation of RESP and PRESERVE Scores

Brunet, Jennifer; Valette, Xavier; Buklas, Dimitrios; Lehoux, Philippe; Verrier, Pierre; Sauneuf, Bertrand; Ivascau, Calin; Dalibert, Yves; Seguin, Amélie; Terzi, Nicolas; Babatasi, Gérard; Cheyron, Damien du; Parienti, Jean‐Jacques; Daubin, Cédric

doi:10.4187/respcare.05098

Cited by 33 publications

(35 citation statements)

References 28 publications

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“…Recently, predictive models have been developed which seek to further support decision making, namely the RESP , PRESERVE and ECMOnet models. These have been proposed as an adjunct to patient selection, yet attempts at external validation demonstrated poor predictive capacity .…”

Section: Discussionmentioning

confidence: 99%

Acceptance and transfer to a regional severe respiratory failure and veno‐venous extracorporeal membrane oxygenation (ECMO) service: predictors and outcomes

et al. 2017

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SummaryThe use of extracorporeal membrane oxygenation for respiratory failure is high risk and resource intensive. In England, five centres provide this service and patients who are referred have four possible outcomes: declined transfer due to perceived futility; accepted in principle but remain at the referring centre with ongoing surveillance; retrieved using conventional ventilation; or retrieved on extracorporeal support. The decision-making process leading to these outcomes has not previously been examined. We evaluated referrals to one centre and identified factors associated with each decision outcome. Five hundred and sixty-four patients were analysed from January 2012 to October 2015. One hundred and fifty-seven patients were declined; multivariate analysis demonstrated associated factors to be: age (odds ratio (95% confidence interval) 1.05 (1.04-1.07)); immunocompromise (4.95 (2

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Section: Discussionmentioning

confidence: 99%

Acceptance and transfer to a regional severe respiratory failure and veno‐venous extracorporeal membrane oxygenation (ECMO) service: predictors and outcomes

et al. 2017

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“…In summary, in those patients with advanced respiratory failure, failing prone positioning maneuvers, and maximal ventilatory therapy, who are otherwise reasonable candidates based upon current risk assessment scoring systems,[ 209 210 ] ECMO should be considered to treat severe COVID-19 pulmonary infections. This view is supported by the American Thoracic Society and the Extracorporeal Life Support Organization.…”

Section: S Ynopsis Of C Linical mentioning

confidence: 99%

The 2019–2020 novel coronavirus (severe acute respiratory syndrome coronavirus 2) pandemic: A joint american college of academic international medicine-world academic council of emergency medicine multidisciplinary COVID-19 working group consensus paper

Stawicki

Jeanmonod

Miller

et al. 2020

J Global Infect Dis

331

356

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What started as a cluster of patients with a mysterious respiratory illness in Wuhan, China, in December 2019, was later determined to be coronavirus disease 2019 (COVID-19). The pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel Betacoronavirus , was subsequently isolated as the causative agent. SARS-CoV-2 is transmitted by respiratory droplets and fomites and presents clinically with fever, fatigue, myalgias, conjunctivitis, anosmia, dysgeusia, sore throat, nasal congestion, cough, dyspnea, nausea, vomiting, and/or diarrhea. In most critical cases, symptoms can escalate into acute respiratory distress syndrome accompanied by a runaway inflammatory cytokine response and multiorgan failure. As of this article's publication date, COVID-19 has spread to approximately 200 countries and territories, with over 4.3 million infections and more than 290,000 deaths as it has escalated into a global pandemic. Public health concerns mount as the situation evolves with an increasing number of infection hotspots around the globe. New information about the virus is emerging just as rapidly. This has led to the prompt development of clinical patient risk stratification tools to aid in determining the need for testing, isolation, monitoring, ventilator support, and disposition. COVID-19 spread is rapid, including imported cases in travelers, cases among close contacts of known infected individuals, and community-acquired cases without a readily identifiable source of infection. Critical shortages of personal protective equipment and ventilators are compounding the stress on overburdened healthcare systems. The continued challenges of social distancing, containment, isolation, and surge capacity in already stressed hospitals, clinics, and emergency departments have led to a swell in technologically-assisted care delivery strategies, such as telemedicine and web-based triage. As the race to develop an effective vaccine intensifies, several clinical trials of antivirals and immune modulators are underway, though no reliable COVID-19-specific therapeutics (inclusive of some potentially effective single and multi-drug regimens) have been identified as of yet. With many nations and regions declaring a state of emergency, unprecedented quarantine, social distancing, and border closing efforts are underway. Implementation of social and physical isolation measures has caused sudden and profound economic hardship, with marked decreases in global trade and local small business activity alike, and full ramifications likely yet to be felt. Current state-of-science, mitigation strategies, possible therapies, ethical considerations for healthcare workers and policymakers, as well as lessons learned for this evolving global threat and the eventual return to a “new normal” are discussed in this article.

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“…In the prospective observational LUNG SAFE study SOFA score was associated with outcome of ARDS [9]. RESP and/or PRESERVE scores have been compared and evaluated in several studies for ECMO therapy [10][11][12][13][14][15][16], but both scores as well as SOFA score have not been validated for ARDS patients treated with a primary extracorporeal CO 2 removal, like pECLA.…”

Section: Introductionmentioning

confidence: 99%

Validation of RESP and PRESERVE score for ARDS patients with pumpless extracorporeal lung assist (pECLA)

et al. 2020

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Background: RESP score and PRESERVE score have been validated for veno-venous Extracorporeal Membrane Oxygenation in severe ARDS to assume individual mortality risk. ARDS patients with low-flow Extracorporeal Carbon Dioxide Removal, especially pumpless Extracorporeal Lung Assist, have also a high mortality rate, but there are no validated specific or general outcome scores. This retrospective study tested whether these established specific risk scores can be validated for pumpless Extracorporeal Lung Assist in ARDS patients in comparison to a general organ dysfunction score, the SOFA score. Methods: In a retrospective single center cohort study we calculated and evaluated RESP, PRESERVE, and SOFA score for 73 ARDS patients with pumpless Extracorporeal Lung Assist treated between 2002 and 2016 using the XENIOS iLA Membrane Ventilator. Six patients had a mild, 40 a moderate and 27 a severe ARDS according to the Berlin criteria. Demographic data and hospital mortality as well as ventilator settings, hemodynamic parameters, and blood gas measurement before and during extracorporeal therapy were recorded. Results: Pumpless Extracorporeal Lung Assist of mechanical ventilated ARDS patients resulted in an optimized lung protective ventilation, significant reduction of P aCO2 , and compensation of acidosis. Scoring showed a mean score of alive versus deceased patients of 3 ± 1 versus − 1 ± 1 for RESP (p < 0.01), 3 ± 0 versus 6 ± 0 for PRESERVE (p < 0.05) and 8 ± 1 versus 10 ± 1 for SOFA (p < 0.05). Using receiver operating characteristic curves, area under the curve (AUC) was 0.78 (95% confidence interval (CI) 0.67-0.89, p < 0.01) for RESP score, 0.80 (95% CI 0.70-0.90, p < 0.0001) for PRESERVE score and 0.66 (95% CI 0.53-0.79, p < 0.05) for SOFA score. Conclusions: RESP and PRESERVE scores were superior to SOFA, as non-specific critical care score. Although scores were developed for veno-venous ECMO, we could validate RESP and PRESERVE score for pumpless Extracorporeal Lung Assist. In conclusion, RESP and PRESERVE score are suitable to estimate mortality risk of ARDS patients with an arterio-venous pumpless Extracorporeal Carbon Dioxide Removal.

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Predicting Survival After Extracorporeal Membrane Oxygenation for ARDS: An External Validation of RESP and PRESERVE Scores

Cited by 33 publications

References 28 publications

Acceptance and transfer to a regional severe respiratory failure and veno‐venous extracorporeal membrane oxygenation (ECMO) service: predictors and outcomes

Acceptance and transfer to a regional severe respiratory failure and veno‐venous extracorporeal membrane oxygenation (ECMO) service: predictors and outcomes

The 2019–2020 novel coronavirus (severe acute respiratory syndrome coronavirus 2) pandemic: A joint american college of academic international medicine-world academic council of emergency medicine multidisciplinary COVID-19 working group consensus paper

Validation of RESP and PRESERVE score for ARDS patients with pumpless extracorporeal lung assist (pECLA)

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