Meld Scoring System to Predict Outcomes in Patients Who Undergo VV ECMO Implantation

Abstract

Veno-venous Extracorporeal membrane oxygenation (VV ECMO) is gaining popularity in the management of severe acute respiratory distress syndrome (ARDS) and bridge patients to lung recovery or transplantation. Several risk factors have been reported to predict prognosis of patients with lung failure. The Model for End-Stage Liver Disease (MELD) system provides a score based on a patient's international normalized ratio (INR) and creatinine and total bilirubin levels. Originally, the score was used to measure mortality risk in patients with end-stage liver disease. In this current analysis, we evaluated the ability of the MELD scoring system to predict clinical outcomes in patients who underwent VV ECMO. We also analyzed the incidence of morbidity including acute kidney injury (AKI), gastrointestinal bleeding (GI bleeding), pump malfunction, oxygenator dysfunction in patients supported with VV ECMO. This is a retrospective review of an institutional ECMO database. We included consecutive patients from January 2015 through February 2019. During the study period, 71 patients underwent VV ECMO implantation at our center and were included in our study (Table 1). Patients were divided into two groups on the basis of their MELD score. Of the 71 patients, Patients were stratified into two cohorts: those with a MELD score <12 (n=50) and ≥12 (n=21). Kaplan-Meier analysis demonstrated a lower overall survival for patients with MELD scores ≥12 who underwent VV ECMO implantation compared to those with MELD scores <12 (p<0.01), and increased risk of AKI (p<0.001) and dialysis (p<0.001) compared to patients with MELD score <12. These findings suggest that a MELD score ≥12 was associated with a higher postoperative mortality rate than that seen in patients with a lower MELD score. MELD scoring system can be used to predict outcomes in patients with advanced respiratory failure patients who undergo VV ECMO implantation.