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

We aimed to test the performance of PRESERVE and RESP scores to predict death in patients with severe ARDS receiving extracorporeal membrane oxygenation (ECMO) with different case mixes. All consecutive patients treated with ECMO for refractory ARDS, regardless of cause, in the Caen University Hospital in northwestern France over the last decade were included in a retrospective cohort study. The receiver operating characteristic curves of each score were plotted, and the area under the curve was computed to assess their performance in predicting mortality (c-index). Forty-one subjects were included. Pre-ECMO ventilator settings were: mean VT, 6.1 ± 0.9 mL/kg; breathing frequency, 32 ± 4 breaths/min; PEEP, 11 ± 4 cm H2O; peak inspiratory pressure, 48 ± 9 cm H2O; plateau pressure, 30.4 ± 4.4 cm H2O. At ECMO initiation, blood gas results were: pH 7.22 ± 0.17, PaO2 /FIO2 = 63 ± 22 mm Hg; PaCO2 = 56 ± 18 mm Hg; FIO2 = 99 ± 2%. Pre-ECMO data were available in 35 and 27 subjects for calculation of the PRESERVE score and RESP score, respectively. Pre-ECMO scoring system results were: median PRESERVE score, 4 (interquartile range 2-5), and median RESP score, 0 (interquartile range -2 to 2). Twenty-three subjects (56%) died, including 19 receiving ECMO. In univariate analysis, plateau pressure (P = .031), driving pressure (P = <.001), and compliance (P = .02) recorded at the time of ECMO initiation as well as the PRESERVE score (P = .032) were significantly associated with mortality. With a c-index of 0.69 (95% CI 0.53-0.87), the PRESERVE score had better discrimination than the RESP score (c-index of 0.60 [95% CI 0.41-0.78]) for predicting mortality. The use of these scores in helping physicians to determine the patients with ARDS most likely to benefit from ECMO should be limited in clinical practice because of their relatively poor performance in predicting death in subjects with severe ARDS receiving ECMO support. Before widespread use is initiated, these scoring systems should be tested in large prospective studies of subjects with severe ARDS undergoing ECMO treatment.

Brunet J ，Valette X ，Buklas D ，Lehoux P ，Verrier P ，Sauneuf B ，Ivascau C ，Dalibert Y ，Seguin A ，Terzi N ，Babatasi G ，du Cheyron D ，Parienti JJ ，Daubin C ... -  《-》

[Predictive values of different critical scoring systems for mortality in patients with severe acute respiratory failure supported by extracorporeal membrane oxygenation].

Wang R ，Sun B ，Li XY ，He HY ，Tang X ，Zhan QY ，Tong ZH ... -  《-》

Performance of Multiple Risk Assessment Tools to Predict Mortality for Adult Respiratory Distress Syndrome with Extracorporeal Membrane Oxygenation Therapy: An External Validation Study Based on Chinese Single-center Data.

Huang L ，Li T ，Xu L ，Hu XM ，Duan DW ，Li ZB ，Gao XJ ，Li J ，Wu P ，Liu YW ，Wang S ，Lang YH ... -  《-》

A Comparative Analysis of Survival Prediction Using PRESERVE and RESP Scores.

Venovenous (VV) extracorporeal membrane oxygenation (ECMO) can be a life-saving therapy for patients with severe acute lung failure refractory to conventional therapy. The respiratory ECMO survival prediction (RESP) score and the predicting death for severe acute respiratory distress syndrome on VV-ECMO (PRESERVE) score were created to predict survival at the time of initiation of ECMO. This study aimed to validate both of these scores externally and to compare their predictive accuracies in patients with non-Western acute respiratory distress syndrome (ARDS). In this retrospective cohort study, we reviewed and extracted data from electronic medical records of consecutive adult ARDS patients who were treated with VV-ECMO from 2007 to 2015. The PRESERVE and RESP scores were calculated for each patient. The outcomes of interest were inhospital and 6-month survival. In all, 99 patients were included. The mean age of the patients was 54 years, and male patients constituted 70% of the cohort. The inhospital and 6-month survival rates were 23% and 22%, respectively. Receiver-operating characteristics curve analysis of the PRESERVE and RESP scores showed area under the curve values of 0.64 and 0.69, respectively (p = 0.53), for inhospital survival. The receiver-operating characteristics areas under the curve for 6-month survival were 0.66 and 0.69, respectively (p = 0.68). The prognostic accuracies of the PRESERVE and RESP scores were thus similar. Both PRESERVE and RESP scores are useful for predicting survival in Asian ARDS patients, and both scores had similar prognostic accuracies in our Korean ARDS cohort.

Kang HR ，Kim DJ ，Lee J ，Cho YJ ，Kim JS ，Lee SM ，Lee JH ，Jheon S ，Lee CT ，Lee YJ ... -  《-》

Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure. The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score.

Schmidt M ，Bailey M ，Sheldrake J ，Hodgson C ，Aubron C ，Rycus PT ，Scheinkestel C ，Cooper DJ ，Brodie D ，Pellegrino V ，Combes A ，Pilcher D ... -  《-》