Validation of prognostic scores in extracorporeal life support: A multi-centric retrospective study

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

Research output: Contribution to journalArticlepeer-review

Abstract

Multiple prognostic scores have been developed for both veno-arterial (VA) and venovenous (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.

Original languageEnglish
Article number84
Pages (from-to)1-12
Number of pages12
JournalMembranes
Volume11
Issue number2
DOIs
Publication statusPublished - Feb 2021

Keywords

  • ECLS
  • ECMO
  • RESP score
  • SAVE score
  • Score
  • Validation

ASJC Scopus subject areas

  • Chemical Engineering (miscellaneous)
  • Process Chemistry and Technology
  • Filtration and Separation

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