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Fisser, Christoph ; Rincon-Gutierrez, Luis Alberto ; Enger, Tone Bull ; Taccone, Fabio Silvio ; Broman, Lars Mikael ; Belliato, Mirko ; Nobile, Leda ; Pappalardo, Federico ; Malfertheiner, Maximilian V.

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.



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Details

Item typeArticle
Journal or Publication TitleMembranes
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
Date24 January 2021
InstitutionsMedicine > Lehrstuhl für Innere Medizin II
Identification Number
ValueType
10.3390/membranes11020084DOI
Keywords; ECMO; score; RESP score; SAVE score; validation; ECLS
Dewey Decimal Classification600 Technology > 610 Medical sciences Medicine
StatusPublished
RefereedYes, this version has been refereed
Created at the University of RegensburgYes
URN of the UB Regensburgurn:nbn:de:bvb:355-epub-444671
Item ID44467

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