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

• Published in: Respiratory care 2017-07, Vol.62 (7), p.912-919
• Main Authors: Brunet, Jennifer, Valette, Xavier, Buklas, Dimitrios, Lehoux, Philippe, Verrier, Pierre, Sauneuf, Bertrand, Ivascau, Calin, Dalibert, Yves, Seguin, Amélie, Terzi, Nicolas, Babatasi, Gérard, du Cheyron, Damien, Parienti, Jean-Jacques, Daubin, Cédric
• Format: Article
• Language: English
• Subjects: Acute respiratory distress syndrome; Adult; Area Under Curve; Blood oxygenation, Extracorporeal; Extracorporeal Membrane Oxygenation - mortality; Female; France; Hospital Mortality; Humans; Male; Maximal Respiratory Pressures - statistics & numerical data; Middle Aged; Patient outcomes; Predictive Value of Tests; Respiration, Artificial - statistics & numerical data; Respiratory Distress Syndrome, Adult - mortality; Respiratory Distress Syndrome, Adult - therapy; Retrospective Studies; ROC Curve; Severity of Illness Index
• ISSN: 0020-1324; 1943-3654
• DOI: 10.4187/respcare.05098

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 V , 6.1 ± 0.9 mL/kg; breathing frequency, 32 ± 4 breaths/min; PEEP, 11 ± 4 cm H O; peak inspiratory pressure, 48 ± 9 cm H O; plateau pressure, 30.4 ± 4.4 cm H O. At ECMO initiation, blood gas results were: pH 7.22 ± 0.17, P /F = 63 ± 22 mm Hg; P = 56 ± 18 mm Hg; F = 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 ( = .031), driving pressure ( =