Predicting survival after extracorporeal membrane oxygenation for ARDS: An external validation of RESP and PRESERVE scores

Abstract

BACKGROUND: 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. METHODS: 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). RESULTS: 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 cmH2O; peak inspiratory pressure, 48 = 9 cmH2O; 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 =