The PRESERVE mortality risk score and analysis of long-term outcomes after extracorporeal membrane oxygenation for severe acute respiratory distress syndrome

Schmidt, Matthieu; Zogheib, Élie; Rozé, Hadrien; Repessé, Xavier; Lebreton, Guillaume; Luyt, Charles‐Édouard; Trouillet, Jean‐Louis; Bréchot, Nicolas; Nieszkowska, Ania; Dupont, Hervé; Ouattara, Alexandre; Leprince, Pascal; Chastre, Jean; Combes, Alain

doi:10.1007/s00134-013-3037-2

Cited by 477 publications

(585 citation statements)

References 51 publications

(91 reference statements)

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“…Recently, several predictive mortality risk scores to help clinicians target the patients most likely to benefit from ECMO have been proposed 18, 21, 22. Among these, age9, 18, 21, 22, 23, 24 and SOFA score21, 22, 23, 24 were found to be particularly closely associated with hospital mortality and were independent prognostic factors in ARDS patients receiving ECMO support.…”

Section: Discussionmentioning

confidence: 99%

Respiratory extracorporeal membrane oxygenation for severe sepsis and septic shock in adults: a propensity score analysis in a multicenter retrospective observational study

Takauji

Hayakawa

Ono

et al. 2017

Acute Medicine & Surgery

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AimThis multicenter retrospective observational study aimed to evaluate the efficacy of extracorporeal membrane oxygenation (ECMO) support for septic patients with severe respiratory failure using propensity score analyses.MethodsThe data of severe sepsis patients from 42 intensive care units between January 2011 and December 2013 were retrospectively collected. Propensity score matching analyses were undertaken for severe respiratory failure patients with/without veno‐venous ECMO support. The main outcome was in‐hospital all‐cause mortality.ResultsOf 3195 patients with severe sepsis, 570 had severe respiratory failure. Forty patients in the ECMO group were matched with 150 patients in the control group. A survival time analysis revealed no difference in the in‐hospital survival (hazard ratio, 0.854; 95% confidence interval, 0.531–1.373; P = 0.515). Two‐hundred and eighty‐five patients had severe respiratory failure induced by lung infection. Twenty‐five ECMO group patients were matched with 89 patients in the control group. In the ECMO group, the survival time was longer than in the control group (hazard ratio, 0.498; 95% confidence interval, 0.279–0.889; P = 0.018). The number of renal replacement therapy‐ and vasopressor‐free days improved. The ECMO group received more red blood cells transfused than the control group, but there was no significant difference in the rate of severe bleeding complications between the groups.ConclusionsThere was no difference in the in‐hospital survival between the ECMO group and control group among overall septic patients with severe respiratory failure. However, in sepsis patients with severe respiratory failure induced by lung infection, ECMO support may improve their survival time.

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Section: Discussionmentioning

confidence: 99%

Respiratory extracorporeal membrane oxygenation for severe sepsis and septic shock in adults: a propensity score analysis in a multicenter retrospective observational study

Takauji

Hayakawa

Ono

et al. 2017

Acute Medicine & Surgery

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“…In addition, when no improvement was observed after 5 days, ECMO was stopped, which prevented any possibility of late clinical improvement. Thirdly, the patients were included in the trial after prolonged mechanical ventilation and it was demonstrated that the deaths of patients who had received ECMO support was strongly associated with the number of days of mechanical ventilation before installation of the device [3]. Indeed, the benefit anticipated with that new technique was to rapidly ensure rest for the lungs due to the highly protective ventilation, before the disease could evolve towards destructive fibrosis.…”

Section: Randomized Trials Of Ecmo In Ards Patientsmentioning

confidence: 99%

“…It must also be emphasized that the most recent studies reported mortality rates for patients with the most severe forms of ARDS, defined as hypoxemia or hypercapnia refractory to initial management and treated conventionally, exceeding 60% [1][2][3]. The results of the first randomized trial were disappointing, but it should be noted that it took place many years ago, when the technology was in its infancy.…”

Section: Why a New Trial Now?mentioning

confidence: 99%

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Indications for extracorporeal support: why do we need the results of the EOLIA trial?

Bréchot

Schmidt

2017

Med Klin Intensivmed Notfmed

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“…Fourth, factors strongly associated with poorer outcomes in series of severe ARDS patients receiving ECMO were older age, a greater number of days of MV before ECMO, a higher number of organ failures, low pre-ECMO respiratory system compliance, absence of paralysis or prone positioning before ECMO, and immunosuppression [15,16]. Based on these factors, predictive survival models have been developed to help clinicians select appropriate candidates for ECMO.…”

Section: Why Should Ecmo Be Initiated Rapidly In This Patient?mentioning

confidence: 99%

Rescue therapy for refractory ARDS should be offered early: yes

Ranieri

2015

Intensive Care Med

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Clinical vignette A previously healthy 51-year-old woman (height 165 cm, weight 60 kg) was admitted to the ICU with severe community acquired pneumonia. She required intubation and mechanical ventilation 6 h after admission. Her respiratory status declined continuously over the next few hours. Twelve hours after admission, blood gases were as follows: pH = 7.36, PaCO 2 = 47 mmHg, PaO 2 = 65 mmHg, HCO 3 -= 26 mmol/L on FiO 2 = 100 %, Vt set at 340 ml, PEEP at 8 cmH 2 O, respiratory rate at 28/min, and plateau pressure measured at 28 cmH 2 O. She was hemodynamically stable and had a normal renal function.This patient has severe ARDS according to the Berlin definition [1]. This patient has very low respiratory system compliance (18 ml/cmH 2 O) and is ventilated with a high driving pressure (20 cmH 2 O). Hypoxemia is extremely severe with a high oxygenation index (43 cmH 2 O/mmHg). Recent clinical studies showed that hospital mortality in patients experiencing such severe forms of ARDS ranges from 45 to 60 % [1-6].What are the first-line options in this situation?This patient receives only 8 cmH 2 O of PEEP. While higher PEEP confers a survival advantage in severe ARDS patients [7], higher levels of PEEP in this patient very likely will further increase the plateau pressure to levels that are certainly associated with an increased risk of ventilator-induced lung injury. Inhaled nitric oxide might have improved arterial oxygenation although this intervention was not shown to improve long-term survival. On the other hand, prone positioning should be rapidly initiated for more than 16 h since a significant increase in survival [8] has been observed in patients with severe ARDS with this maneuver. This patient should also receive continuous infusion of neuromuscular blockade agents [9].What is the rationale for applying ''ultraprotective'' MV in this situation?Lung hyperinflation occurs in approximately 30 % of ARDS patients ventilated using the protective ARDSNet strategy [10]. Moreover, Hager and co-workers retrospectively analyzing data of the ''ARDSNet'' trial group show a linear relationship between mortality and P plat -a linear relationship in the sense that the lower P plat , the lower the mortality, even for P plat less than 30 cmH 2 O [11]. In a proof of concept study, Terragni et al. [12] demonstrated that very low tidal volume ventilation Intensive Care Med (2015) 41:923-925

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The PRESERVE mortality risk score and analysis of long-term outcomes after extracorporeal membrane oxygenation for severe acute respiratory distress syndrome

Abstract: The PRESERVE score might help ICU physicians select appropriate candidates for ECMO among severe ARDS patients. Future studies should also focus on physical and psychosocial rehabilitation that could lead to improved HRQL in this population.

Cited by 477 publications

References 51 publications

Respiratory extracorporeal membrane oxygenation for severe sepsis and septic shock in adults: a propensity score analysis in a multicenter retrospective observational study

Respiratory extracorporeal membrane oxygenation for severe sepsis and septic shock in adults: a propensity score analysis in a multicenter retrospective observational study

Indications for extracorporeal support: why do we need the results of the EOLIA trial?

Rescue therapy for refractory ARDS should be offered early: yes

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