Evaluation of the discrimination and calibration of predictive scores of mortality in <scp>ECMO</scp> for patients with <scp>COVID</scp>‐19

Huespe, Iván; Lockhart, Carolina; Kashyap, Rahul; Pálizas, Fernando; Colombo, Malena; Romero, María del Pilar; Prado, Eduardo; García, Christian A Casabella; Heras, Marcos Las; Bisso, Indalecio Carboni

doi:10.1111/aor.14493

Cited by 3 publications

(1 citation statement)

References 41 publications

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“…It is interesting to observe how the scales most used and recommended by the ELSO (Extracorporeal Live Support Organization) to predict mortality before the start of ECMO is the RESP score (respiratory ECMO survival prediction) and includes the number of days that patients have been on mechanical ventilation, but this period of time only includes since the start of ECMO. The patient was intubated and does not consider the time on previous NIV to intubation (15,16,17).…”

Section: Introductionmentioning

confidence: 99%

Days spent on non-invasive ventilation support: Can it determine when to initiate VV-ECMO? Observational study in a cohort of Covid-19 patients.

Fuset-Cabanes

Hernández-Platero

Sabater-Riera

et al. 2023

Preprint

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Background: The study evaluates the impact of the time between commencing non-invasive ventilation (NIV) support and initiation of venovenous extracorporeal membrane oxygenation (VV-ECMO) in a cohort of critically ill patients with coronavirus disease 2019 (COVID-19) associated acute respiratory distress syndrome (ARDS). Methods: Prospective observational study design in an intensive Care Unit (ICU) of a tertiary hospital in Barcelona (Spain). All patients requiring VV-ECMO support due to COVID-19 associated ARDS between March 2020 and January 2022 were analysed. Survival outcome was determined at 90 days after VV-ECMO initiation. Demographic data, comorbidities at ICU admission, RESP (respiratory ECMO survival prediction) score, antiviral and immunomodulatory treatments received, inflammatory biomarkers, the need for vasopressors, the thromboprophylaxis regimen received, and respiratory parameters including the length of intubation previous to ECMO and the length of each NIV support (high-flow nasal cannula, continuous positive airway pressure and bi-level positive airway pressure), were also collated in order to assess risk factors for day-90 mortality. The effect of the time lapse between NIV support and VV-ECMO on survival was evaluated using logistic regression and adjusting the association with all factors that were significant in the univariate analysis. Results: Seventy-two patients finally received VV-ECMO support. At 90 days after commencing VV-ECMO 35 (48%) had died and 37 (52%) were alive. Multivariable analysis showed that at VV-ECMO initiation, age (p=0.02), lactate (p=0.001), and days from initiation of NIV support to starting VV-ECMO (p=0.04) were all associated with day-90 mortality. Conclusions: In our small cohort of VV-ECMO patients with COVID-19 associated ARDS, the time spent between initiation of NIV support and VV-ECMO (together with age and lactate) appear to be a better predictor of mortality than that between intubation and VV-ECMO.

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Section: Introductionmentioning

confidence: 99%

Days spent on non-invasive ventilation support: Can it determine when to initiate VV-ECMO? Observational study in a cohort of Covid-19 patients.

Fuset-Cabanes

Hernández-Platero

Sabater-Riera

et al. 2023

Preprint

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Complications during extracorporeal membrane oxygenation transfer in Argentina: A multicenter observational study

Carrizo,

Avila,

Huespe

et al. 2024

Artificial Organs

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BackgroundThere is a lack of documented cases regarding complications during ECMO transfer in middle‐income countries. Using portable ECMO devices facilitates patient transport but entails significantly higher costs, necessitating evidence of their practical utility. This study aims to describe complications during ECMO transfer in Argentina and to compare complication rates between the integrated portable ECMO and non‐portable ECMO systems.MethodsA multicenter observational retrospective study was conducted across four high‐complexity hospitals in Argentina. Patients over 18 years old who underwent ECMO transfer between January 2017 and July 2023 were included. Complications were classified based on the Ericsson severity classification, a widely accepted system that categorizes complications based on their severity and the need for immediate organ support. The effect of the ECMO systems (portable and non‐portable ECMO system) on complication rates was assessed using logistic regression weighted by inverse probability weighting (IPWT) analysis after propensity score assessment to adjust for confounders.ResultsThe study included 65 patients who were transferred for ECMO. Complications occurred in 40% (95%CI: 28%, 52%; n=26) of transfers, with grade 2 complications being the most prevalent at 20% (95%CI 11%, 32%; n=13). Integrated portable ECMO systems were associated with fewer complications during ECMO transfer, showing a crude OR of 0.25 (95%CI 0.08, 0.75), and after adjustment by IPWT, an OR of 0.27 (95%CI 0.08, 0.93).ConclusionsECMO transfers in middle‐income countries exhibit complication rates similar to those in high‐income countries. Our study found fewer complications in transfers using integrated portable ECMO systems and those involving distances exceeding 100 km. These findings suggest that the use of portable ECMO systems, despite their higher costs, may be beneficial in reducing complications during patient transport in middle‐income countries.

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Days spent on non-invasive ventilation support: can it determine when to initiate VV- ECMO? Observational study in a cohort of Covid-19 patients

Fuset-Cabanes,

Hernández-Platero,

Sabater-Riera

et al. 2023

BMC Pulm Med

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Background The study evaluates the impact of the time between commencing non-invasive ventilation (NIV) support and initiation of venovenous extracorporeal membrane oxygenation (VV-ECMO) in a cohort of critically ill patients with coronavirus disease 2019 (COVID-19) associated acute respiratory distress syndrome (ARDS). Methods Prospective observational study design in an intensive Care Unit (ICU) of a tertiary hospital in Barcelona (Spain). All patients requiring VV-ECMO support due to COVID-19 associated ARDS between March 2020 and January 2022 were analysed. Survival outcome was determined at 90 days after VV-ECMO initiation. Demographic data, comorbidities at ICU admission, RESP (respiratory ECMO survival prediction) score, antiviral and immunomodulatory treatments received, inflammatory biomarkers, the need for vasopressors, the thromboprophylaxis regimen received, and respiratory parameters including the length of intubation previous to ECMO and the length of each NIV support (high-flow nasal cannula, continuous positive airway pressure and bi-level positive airway pressure), were also collated in order to assess risk factors for day-90 mortality. The effect of the time lapse between NIV support and VV-ECMO on survival was evaluated using logistic regression and adjusting the association with all factors that were significant in the univariate analysis. Results Seventy-two patients finally received VV-ECMO support. At 90 days after commencing VV-ECMO 35 patients (48%) had died and 37 patients (52%) were alive. Multivariable analysis showed that at VV-ECMO initiation, age (p = 0.02), lactate (p = 0.001), and days from initiation of NIV support to starting VV-ECMO (p = 0.04) were all associated with day-90 mortality. Conclusions In our small cohort of VV-ECMO patients with COVID-19 associated ARDS, the time spent between initiation of NIV support and VV-ECMO (together with age and lactate) appeared to be a better predictor of mortality than the time between intubation and VV-ECMO.

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Evaluation of the discrimination and calibration of predictive scores of mortality in ECMO for patients with COVID‐19

Cited by 3 publications

References 41 publications

Days spent on non-invasive ventilation support: Can it determine when to initiate VV-ECMO? Observational study in a cohort of Covid-19 patients.

Days spent on non-invasive ventilation support: Can it determine when to initiate VV-ECMO? Observational study in a cohort of Covid-19 patients.

Complications during extracorporeal membrane oxygenation transfer in Argentina: A multicenter observational study

Days spent on non-invasive ventilation support: can it determine when to initiate VV- ECMO? Observational study in a cohort of Covid-19 patients

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