Predicting Survival after Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Failure. The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) Score

Schmidt, Matthieu; Bailey, Michael; Sheldrake, Jayne; Hodgson, Carol; Aubron, Cécile; Rycus, Peter; Scheinkestel, Carlos; Cooper, Jamie; Brodie, Daniel; Pellegrino, Vincent; Combes, Alain; Pilcher, David

doi:10.1164/rccm.201311-2023oc

Cited by 671 publications

(782 citation statements)

References 30 publications

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“…In the present case, the patient needed higher PEEP settings due to worsening oxygenation before ECMO introduction. In terms of timing of ECMO initiation, it seems ideal to start ECMO within 7 days from ventilator introduction based on the ELSO guideline12 and Respiratory ECMO Survival Prediction (RESP) score 14. In addition, as Goodman et al 4.…”

Section: Discussionmentioning

confidence: 99%

Severe acute respiratory distress syndrome in a patient with AIDS successfully treated with veno‐venous extracorporeal membrane oxygenation: a case report and literature review

Obata

Azuma

Nakamura

et al. 2018

Acute Medicine & Surgery

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CaseSeveral successful uses of extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome in patients with novel HIV/AIDS infection have been reported; however, the therapeutic keys have not always been discussed.A 47‐year‐old man was admitted with progressive shortness of breath. He was in respiratory failure with a PaO2/FIO2 ratio of 110.8 requiring intubation. Chest computed tomography showed diffuse ground glass opacities. An HIV infection was suspected, and a diagnosis of acute respiratory distress syndrome was made. Based on clinical indications, treatment for Pneumocystis jirovecii pneumonia and concomitant bacterial infection was started.OutcomeDespite broad‐spectrum antibiotics, the patient's oxygenation deteriorated, necessitating ECMO. After 19 days of ECMO therapy, the patient was successfully decannulated and was eventually discharged.ConclusionIn acute respiratory distress syndrome in patients with HIV/AIDS refractory to treatment, ECMO should be considered. Post‐ECMO antiretroviral therapy could improve outcomes.

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Section: Discussionmentioning

confidence: 99%

Severe acute respiratory distress syndrome in a patient with AIDS successfully treated with veno‐venous extracorporeal membrane oxygenation: a case report and literature review

Obata

Azuma

Nakamura

et al. 2018

Acute Medicine & Surgery

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“…Previous studies have shown that the mortality rate among patients with non‐pulmonary sepsis‐induced acute respiratory distress syndrome (ARDS) was higher than in patients with pulmonary sepsis‐induced ARDS 18, 19. Nesseler et al 19.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, several predictive mortality risk scores to help clinicians target the patients most likely to benefit from ECMO have been proposed 18, 21, 22. Among these, age9, 18, 21, 22, 23, 24 and SOFA score21, 22, 23, 24 were found to be particularly closely associated with hospital mortality and were independent prognostic factors in ARDS patients receiving ECMO support.…”

Section: Discussionmentioning

confidence: 99%

Respiratory extracorporeal membrane oxygenation for severe sepsis and septic shock in adults: a propensity score analysis in a multicenter retrospective observational study

Takauji

Hayakawa

Ono

et al. 2017

Acute Medicine & Surgery

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AimThis multicenter retrospective observational study aimed to evaluate the efficacy of extracorporeal membrane oxygenation (ECMO) support for septic patients with severe respiratory failure using propensity score analyses.MethodsThe data of severe sepsis patients from 42 intensive care units between January 2011 and December 2013 were retrospectively collected. Propensity score matching analyses were undertaken for severe respiratory failure patients with/without veno‐venous ECMO support. The main outcome was in‐hospital all‐cause mortality.ResultsOf 3195 patients with severe sepsis, 570 had severe respiratory failure. Forty patients in the ECMO group were matched with 150 patients in the control group. A survival time analysis revealed no difference in the in‐hospital survival (hazard ratio, 0.854; 95% confidence interval, 0.531–1.373; P = 0.515). Two‐hundred and eighty‐five patients had severe respiratory failure induced by lung infection. Twenty‐five ECMO group patients were matched with 89 patients in the control group. In the ECMO group, the survival time was longer than in the control group (hazard ratio, 0.498; 95% confidence interval, 0.279–0.889; P = 0.018). The number of renal replacement therapy‐ and vasopressor‐free days improved. The ECMO group received more red blood cells transfused than the control group, but there was no significant difference in the rate of severe bleeding complications between the groups.ConclusionsThere was no difference in the in‐hospital survival between the ECMO group and control group among overall septic patients with severe respiratory failure. However, in sepsis patients with severe respiratory failure induced by lung infection, ECMO support may improve their survival time.

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“…Third, recent series and a randomized trial demonstrated better survival for patients receiving ECMO for severe ARDS [2][3][4]15]. The CESAR trial [3] evaluated a strategy of transfer to a single center which had ECMO capability while the patients randomized to the control group received conventional MV.…”

Section: Why Should Ecmo Be Initiated Rapidly In This Patient?mentioning

confidence: 99%

Rescue therapy for refractory ARDS should be offered early: yes

Ranieri

2015

Intensive Care Med

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Clinical vignette A previously healthy 51-year-old woman (height 165 cm, weight 60 kg) was admitted to the ICU with severe community acquired pneumonia. She required intubation and mechanical ventilation 6 h after admission. Her respiratory status declined continuously over the next few hours. Twelve hours after admission, blood gases were as follows: pH = 7.36, PaCO 2 = 47 mmHg, PaO 2 = 65 mmHg, HCO 3 -= 26 mmol/L on FiO 2 = 100 %, Vt set at 340 ml, PEEP at 8 cmH 2 O, respiratory rate at 28/min, and plateau pressure measured at 28 cmH 2 O. She was hemodynamically stable and had a normal renal function.This patient has severe ARDS according to the Berlin definition [1]. This patient has very low respiratory system compliance (18 ml/cmH 2 O) and is ventilated with a high driving pressure (20 cmH 2 O). Hypoxemia is extremely severe with a high oxygenation index (43 cmH 2 O/mmHg). Recent clinical studies showed that hospital mortality in patients experiencing such severe forms of ARDS ranges from 45 to 60 % [1-6].What are the first-line options in this situation?This patient receives only 8 cmH 2 O of PEEP. While higher PEEP confers a survival advantage in severe ARDS patients [7], higher levels of PEEP in this patient very likely will further increase the plateau pressure to levels that are certainly associated with an increased risk of ventilator-induced lung injury. Inhaled nitric oxide might have improved arterial oxygenation although this intervention was not shown to improve long-term survival. On the other hand, prone positioning should be rapidly initiated for more than 16 h since a significant increase in survival [8] has been observed in patients with severe ARDS with this maneuver. This patient should also receive continuous infusion of neuromuscular blockade agents [9].What is the rationale for applying ''ultraprotective'' MV in this situation?Lung hyperinflation occurs in approximately 30 % of ARDS patients ventilated using the protective ARDSNet strategy [10]. Moreover, Hager and co-workers retrospectively analyzing data of the ''ARDSNet'' trial group show a linear relationship between mortality and P plat -a linear relationship in the sense that the lower P plat , the lower the mortality, even for P plat less than 30 cmH 2 O [11]. In a proof of concept study, Terragni et al. [12] demonstrated that very low tidal volume ventilation Intensive Care Med (2015) 41:923-925

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Predicting Survival after Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Failure. The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) Score

Abstract: The RESP score is a relevant and validated tool to predict survival for patients receiving ECMO for respiratory failure.

Cited by 671 publications

References 30 publications

Severe acute respiratory distress syndrome in a patient with AIDS successfully treated with veno‐venous extracorporeal membrane oxygenation: a case report and literature review

Severe acute respiratory distress syndrome in a patient with AIDS successfully treated with veno‐venous extracorporeal membrane oxygenation: a case report and literature review

Respiratory extracorporeal membrane oxygenation for severe sepsis and septic shock in adults: a propensity score analysis in a multicenter retrospective observational study

Rescue therapy for refractory ARDS should be offered early: yes

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