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


OBJECTIVE
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 methodology with internal and external validation.


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, PaCO2, 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.
1 Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, Melbourne, Australia.
Matthieu
M
Schmidt
Michael
M
Bailey
Jayne
J
Sheldrake
Carol
C
Hodgson
Cecile
C
Aubron
Peter T
PT
Rycus
Carlos
C
Scheinkestel
D Jamie
DJ
Cooper
Daniel
D
Brodie
Vincent
V
Pellegrino
Alain
A
Combes
David
D
Pilcher
D000328:Adult; D001315:Australia / Q000453:epidemiology; D015199:Extracorporeal Membrane Oxygenation / Q000191:economics / Q000401:mortality / Q000451:nursing*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D011237:Predictive Value of Tests; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000401:mortality / Q000451:nursing* / Q000628:therapy; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology