Validation of RESP and PRESERVE score for ARDS patients with pumpless Extracorporeal Lung Assist (pECLA)

Abstract

Background: 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 also a high mortality rate, but there are no validated specific or general outcome scores. Methods: In a retrospective single center cohort study we calculated and evaluated RESP, PRESERVE, and SOFA score for 73 ARDS patients with pumpless Extracorporeal Lung Assist. Additionally, demographic data and hospital mortality as well as ventilator settings, hemodynamic parameters, and blood gas measurement before and during extracorporeal therapy were recorded. Results: Pumpless 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. Conclusions: RESP 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.

Extracorporeal carbon dioxide removal in acute hypoxaemic respiratory failure: a systematic review, Bayesian meta-analysis and trial sequential analysis

“…54 articles were retrieved for full-text review, 21 of which were finally included in the systematic review and meta-analysis. These included three randomised controlled trials [8,17,18], totalling 531 patients, and 18 observational studies [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36], ranging from non-randomised controlled designs to retrospective cohort studies. Most studies were published in the past decade (n=15, 71%) [8,18,[24][25][26][27][28][29][30][31][32][33][34][35][36] and evaluated veno-venous ECCO 2 R (n=12, 57%) [8, 17, 19, 21, 27, 29-33, 35, 36].…”

“…For observational studies, 12 studies reported a mortality outcome (five hospital mortality [18,19,22,24,34], two 28-day mortality [29,36], three both hospital and 28-day mortality [23,28,31] and two ICU mortality [25,27]). Among studies including >50 patients, reported mortality ranged from 37.9% to 58.9% [20,22,28,30,31,34].…”