Abstract
BackgroundRESP score and PRESERVE score have been validated for veno-venous Extracorporeal Membrane Oxygenation in severe ARDS to assume individual mortality risk. ARDS patients with low-flow Extracorporeal Carbon Dioxide Removal, especially pumpless Extracorporeal Lung Assist, have also a high mortality rate, but there are no validated specific or general outcome scores. This retrospective study tested whether these established specific risk scores can be validated for pumpless Extracorporeal Lung Assist in ARDS patients in comparison to a general organ dysfunction score, the SOFA score.MethodsIn a retrospective single center cohort study we calculated and evaluated RESP, PRESERVE, and SOFA score for 73 ARDS patients with pumpless Extracorporeal Lung Assist treated between 2002 and 2016 using the XENIOS iLA Membrane Ventilator. Six patients had a mild, 40 a moderate and 27 a severe ARDS according to the Berlin criteria. Demographic data and hospital mortality as well as ventilator settings, hemodynamic parameters, and blood gas measurement before and during extracorporeal therapy were recorded.ResultsPumpless Extracorporeal Lung Assist of mechanical ventilated ARDS patients resulted in an optimized lung protective ventilation, significant reduction of PaCO2, and compensation of acidosis. Scoring showed a mean score of alive versus deceased patients of 3 ± 1 versus − 1 ± 1 for RESP (p < 0.01), 3 ± 0 versus 6 ± 0 for PRESERVE (p < 0.05) and 8 ± 1 versus 10 ± 1 for SOFA (p < 0.05). Using receiver operating characteristic curves, area under the curve (AUC) was 0.78 (95% confidence interval (CI) 0.67–0.89, p < 0.01) for RESP score, 0.80 (95% CI 0.70–0.90, p < 0.0001) for PRESERVE score and 0.66 (95% CI 0.53–0.79, p < 0.05) for SOFA score.ConclusionsRESP and PRESERVE scores were superior to SOFA, as non-specific critical care score. Although scores were developed for veno-venous ECMO, we could validate RESP and PRESERVE score for pumpless Extracorporeal Lung Assist. In conclusion, RESP and PRESERVE score are suitable to estimate mortality risk of ARDS patients with an arterio-venous pumpless Extracorporeal Carbon Dioxide Removal.
Highlights
Respiratory ECMO Survival Prediction (RESP) score and PRESERVE score have been validated for veno-venous Extracorporeal Membrane Oxygenation in severe Acute respiratory distress syndrome (ARDS) to assume individual mortality risk
It demonstrated efficient extracorporeal carbon dioxide elimination resulting in lung protective ventilation without respiratory acidosis [5] and reducing the risk of ventilator induced lung injury (VILI) [5,6,7]. pumpless Extracorporeal Lung Assist (pECLA) therapy is limited by a low oxygen transfer with only moderate increase of oxygenation
Fifty-two patients had a severe hypercapnia with a Arterial partial pressure of carbon dioxide (PaCO2) ≥ 60 mmHg and 28 a severe acidosis with a pH < 7.2
Summary
RESP score and PRESERVE score have been validated for veno-venous Extracorporeal Membrane Oxygenation in severe ARDS to assume individual mortality risk. ARDS patients with low-flow Extracorporeal Carbon Dioxide Removal, especially pumpless Extracorporeal Lung Assist, have a high mortality rate, but there are no validated specific or general outcome scores. Arteriovenous pECLA represents a specific subgroup of ECCO2R using a simplified extracorporeal lung assist technique for patients with hypercapnia and respiratory acidosis without cardiac failure. It demonstrated efficient extracorporeal carbon dioxide elimination resulting in lung protective ventilation without respiratory acidosis [5] and reducing the risk of ventilator induced lung injury (VILI) [5,6,7]. It demonstrated efficient extracorporeal carbon dioxide elimination resulting in lung protective ventilation without respiratory acidosis [5] and reducing the risk of ventilator induced lung injury (VILI) [5,6,7]. pECLA therapy is limited by a low oxygen transfer with only moderate increase of oxygenation
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