Jennifer Brunet1, Xavier Valette2, Dimitrios Buklas3, Philippe Lehoux4, Pierre Verrier1, Bertrand Sauneuf5, Calin Ivascau3, Yves Dalibert3, Amélie Seguin2, Nicolas Terzi6, Gérard Babatasi3, Damien du Cheyron2,7, Jean-Jacques Parienti8,7, Cédric Daubin9. 1. Department of Anesthesiology. 2. Department of Medical Intensive Care. 3. Department of Thoracic and Cardiovascular Surgery. 4. Department of Medical Intensive Care, CHG de Saint-Lô, Saint-Lô, France. 5. Department of Medical Intensive Care, CHG de Cherbourg, Cherbourg, France. 6. Department of Medical Intensive Care, CHU de Grenoble Alpes, and INSERM, U1042, University of Grenoble-Alpes, HP2, Grenoble, France. 7. Normandy University and U2RM, EA 4655, University of Caen, Lower Normandy, Caen, France. 8. Department of Biostatistics and Clinical Research, CHU de Caen, Caen, France. 9. Department of Medical Intensive Care daubin-c@chu-caen.fr.
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 cm H2O; peak inspiratory pressure, 48 ± 9 cm H2O; 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 = <.001), and compliance (P = .02) recorded at the time of ECMO initiation as well as the PRESERVE score (P = .032) were significantly associated with mortality. With a c-index of 0.69 (95% CI 0.53-0.87), the PRESERVE score had better discrimination than the RESP score (c-index of 0.60 [95% CI 0.41-0.78]) for predicting mortality. CONCLUSIONS: The use of these scores in helping physicians to determine the patients with ARDS most likely to benefit from ECMO should be limited in clinical practice because of their relatively poor performance in predicting death in subjects with severe ARDS receiving ECMO support. Before widespread use is initiated, these scoring systems should be tested in large prospective studies of subjects with severe ARDS undergoing ECMO treatment.
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 cm H2O; peak inspiratory pressure, 48 ± 9 cm H2O; 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 = <.001), and compliance (P = .02) recorded at the time of ECMO initiation as well as the PRESERVE score (P = .032) were significantly associated with mortality. With a c-index of 0.69 (95% CI 0.53-0.87), the PRESERVE score had better discrimination than the RESP score (c-index of 0.60 [95% CI 0.41-0.78]) for predicting mortality. CONCLUSIONS: The use of these scores in helping physicians to determine the patients with ARDS most likely to benefit from ECMO should be limited in clinical practice because of their relatively poor performance in predicting death in subjects with severe ARDS receiving ECMO support. Before widespread use is initiated, these scoring systems should be tested in large prospective studies of subjects with severe ARDS undergoing ECMO treatment.
Authors: Stanislaw P Stawicki; Rebecca Jeanmonod; Andrew C Miller; Lorenzo Paladino; David F Gaieski; Anna Q Yaffee; Annelies De Wulf; Joydeep Grover; Thomas J Papadimos; Christina Bloem; Sagar C Galwankar; Vivek Chauhan; Michael S Firstenberg; Salvatore Di Somma; Donald Jeanmonod; Sona M Garg; Veronica Tucci; Harry L Anderson; Lateef Fatimah; Tamara J Worlton; Siddharth P Dubhashi; Krystal S Glaze; Sagar Sinha; Ijeoma Nnodim Opara; Vikas Yellapu; Dhanashree Kelkar; Ayman El-Menyar; Vimal Krishnan; S Venkataramanaiah; Yan Leyfman; Hassan Ali Saoud Al Thani; Prabath Wb Nanayakkara; Sudip Nanda; Eric Cioè-Peña; Indrani Sardesai; Shruti Chandra; Aruna Munasinghe; Vibha Dutta; Silvana Teixeira Dal Ponte; Ricardo Izurieta; Juan A Asensio; Manish Garg Journal: J Glob Infect Dis Date: 2020-05-22
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Authors: Joe Zhang; Blair Merrick; Genex L Correa; Luigi Camporota; Andrew Retter; Andrew Doyle; Guy W Glover; Peter B Sherren; Stephen J Tricklebank; Sangita Agarwal; Boris E Lams; Nicholas A Barrett; Nicholas Ioannou; Jonathan Edgeworth; Christopher I S Meadows Journal: ERJ Open Res Date: 2020-10-26