Journal
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
Volume 189, Issue 11, Pages 1374-1382Publisher
AMER THORACIC SOC
DOI: 10.1164/rccm.201311-2023OC
Keywords
predictive score model; extracorporeal membrane oxygenation; acute respiratory distress syndrome; outcome; adult
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Funding
- 2013 ELSO Research Grant
- French Intensive Care Society
- Fonds de Dotation Recherche en Sante Respiratoire
- College des Enseignants de Reanimation Medicale
- Fonds d'Etude et de Recherche du Corps Medical des Hopitaux de Paris
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Rationale: Increasing use of extracorporeal membrane oxygenation (ECMO) for acute respiratory failure may increase resource requirements and hospital costs. Better prediction of survival in these patients may improve resource use, allow risk-adjusted comparison of center-specific outcomes, and help clinicians to target patients most likely to benefit from ECMO. Objectives: To create a model for predicting hospital survival at initiation of ECMO for respiratory failure. Methods: Adult patients with severe acute respiratory failure treated by ECMO from 2000 to 2012 were extracted from the Extracorporeal Life Support Organization (ELSO) international registry. Multivariable logistic regression was used to create the Respiratory ECMO Survival Prediction (RESP) score using bootstrapping methodorogy with internal and external validation. Measurements and Main Results: Of the 2,355 patients included in the study, 1,338 patients (57%) were discharged alive from hospital. The RESP score was developed using pre-ECMO variables independently associated with hospital survival on logistic regression, which included age, immunocompromised status, duration of mechanical ventilation before ECMO, diagnosis, central nervous system dysfunction, acute associated nonpulmonary infection, neuromuscular blockade agents or nitric oxide use, bicarbonate infusion, cardiac arrest, Pa-CO2, and peak inspiratory pressure. The receiver operating characteristics Curve analysis of the RESP score was c = 0.74 (95% confidence interval, 0.72-0.76). External validation, performed on 140 patients, exhibited excellent discrimination (c = 0.92; 95% confidence interval, 0.89-0.97). Conclusions: The RESP score is a relevant and validated tool to predict survival for patients receiving ECMO for respiratory failure.
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