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Validation of Prognostic Scores in Extracorporeal Life Support: A Multi-Centric Retrospective Study
Fisser, Christoph, Rincon-Gutierrez, Luis Alberto, Enger, Tone Bull, Taccone, Fabio Silvio, Broman, Lars Mikael
, Belliato, Mirko, Nobile, Leda, Pappalardo, Federico
and Malfertheiner, Maximilian V.
(2021)
Validation of Prognostic Scores in Extracorporeal Life Support: A Multi-Centric Retrospective Study.
Membranes 2021 (11,84), pp. 1-12.
Date of publication of this fulltext: 28 Jan 2021 09:56
Article
DOI to cite this document: 10.5283/epub.44467
Abstract
Multiple prognostic scores have been developed for both veno-arterial (VA) and veno-venous (VV) extracorporeal membrane oxygenation (ECMO), mostly in single-center cohorts. The aim of this study was to compare and validate different prediction scores in a large multicenter ECMO-population. Methods: Data from five ECMO centers included 300 patients on VA and 329 on VV ECMO support (March 2008 to ...
Multiple prognostic scores have been developed for both veno-arterial (VA) and veno-venous (VV) extracorporeal membrane oxygenation (ECMO), mostly in single-center cohorts. The aim of this study was to compare and validate different prediction scores in a large multicenter ECMO-population. Methods: Data from five ECMO centers included 300 patients on VA and 329 on VV ECMO support (March 2008 to November 2016). Different prognostic scores were compared between survivors and non-survivors: APACHE II, SOFA, SAPS II in all patients; SAVE, modified SAVE and MELD-XI in VA ECMO; RESP, PRESET, ROCH and PRESERVE in VV ECMO. Model performance was compared using receiver-operating-curve analysis and assessment of model calibration. Survival was assessed at intensive care unit discharge. Results: The main indication for VA ECMO was cardiogenic shock; overall survival was 51%. ICU survivors had higher Glasgow Coma Scale scores and pH, required cardiopulmonary resuscitation (CPR) less frequently, had lower lactate levels and shorter ventilation time pre-ECMO at baseline. The best discrimination between survivors and non-survivors was observed with the SAPS II score (area under the curve [AUC] of 0.73 (95% CI 0.67-0.78)). The main indication for VV ECMO was pneumonia; overall survival was 60%. Lower PaCO2, higher pH, lower lactate and lesser need for CPR were observed among survivors. The best discrimination between survivors and non-survivors was observed with the PRESET score (AUC 0.66 (95% CI 0.60-0.72)). Conclusion: The prognostic performance of most scores was moderate in ECMO patients. The use of such scores to decide about ECMO implementation in potential candidates should be discouraged.
Involved Institutions
Details
| Item type | Article | ||||
| Journal or Publication Title | Membranes | ||||
| Publisher: | MDPI | ||||
|---|---|---|---|---|---|
| Open Access Type: | Gold (with APC) | ||||
| Place of Publication: | BASEL | ||||
| Volume: | 2021 | ||||
| Number of Issue or Book Chapter: | 11,84 | ||||
| Page Range: | pp. 1-12 | ||||
| Date | 24 January 2021 | ||||
| Institutions | Medicine > Lehrstuhl für Innere Medizin II | ||||
| Identification Number |
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| Keywords | ; ECMO; score; RESP score; SAVE score; validation; ECLS | ||||
| Dewey Decimal Classification | 600 Technology > 610 Medical sciences Medicine | ||||
| Status | Published | ||||
| Refereed | Yes, this version has been refereed | ||||
| Created at the University of Regensburg | Yes | ||||
| URN of the UB Regensburg | urn:nbn:de:bvb:355-epub-444671 | ||||
| Item ID | 44467 |
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