What’s new with survival prediction models in acute respiratory failure patients requiring extracorporeal membrane oxygenation

Objective: To analyze the management and outcome of patients with refractory respiratory failure complicating severe Legionella pneumonia rescued with extracorporeal membrane oxygenation (ECMO) in our Center. Design and Setting: Observational study of patients with refractory respiratory failure treated with ECMO in Hospital S.João (Porto, Portugal), between November 2009 and September 2016. Participants: A total of 112 patients rescued with ECMO, of which 14 had Legionella pneumonia. Results: Patients with Legionella pneumonia were slightly older than patients with acute respiratory failure of other etiologies (51 [48-56] vs 45 [35-54]), but with no significant differences in acute respiratory failure severity between groups: Pao2/Fio2 ratio 67 (60-75) versus 69 (55-85) and Respiratory Extracorporeal Membrane Oxygenation Survival Prediction score 4 (1-5) versus 2 (-1-4), respectively. Legionella pneumonia was associated with earlier ECMO initiation (days of invasive mechanical ventilation [IMV] before ECMO: 2.0 [1.0-4.0] vs 5.0 [2.0-9.5]). After IMV adjustment to “lung rest” settings, this group presented higher respiratory system (RS) static compliance (28.7 [18.8-37.4] vs 16.0 [10.0-20.8] mL/cmH2O) but required higher ECMO support (blood flow 5.0 [4.3-5.4] vs 4.2 [3.6-4.8]). Patients with Legionella pneumonia had shorter IMV (16 [14-23] vs 27 [20-42] days) and lower incidence of intensive care unit nosocomial infections (35.7% vs 64.3%), with a trend to higher hospital survival (85.7% vs 62.2%; P = .13). Conclusion: In Legionella pneumonia complicated by refractory respiratory failure, ECMO support allowed patient stabilization under lung protective ventilation and high survival rates. Timely ECMO referral should be considered for Legionella pneumonia failing conventional treatment.

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Mortality prediction models in acute respiratory failure treated with extracorporeal membrane oxygenation: it must be firstly designed for clinicians and beside use

Critical Care ◽

10.1186/cc13967 ◽

2014 ◽

Vol 18 (4) ◽

pp. 445 ◽

Cited By ~ 2

Author(s):

Matthieu Schmidt ◽

David Pilcher

Keyword(s):

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Acute Respiratory Failure ◽

Prediction Models ◽

Mortality Prediction ◽

Membrane Oxygenation ◽

Mortality Prediction Models

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

American Journal of Respiratory and Critical Care Medicine ◽

10.1164/rccm.201311-2023oc ◽

2014 ◽

Vol 189 (11) ◽

pp. 1374-1382 ◽

Cited By ~ 290

Author(s):

Matthieu Schmidt ◽

Michael Bailey ◽

Jayne Sheldrake ◽

Carol Hodgson ◽

Cecile Aubron ◽

...

Keyword(s):

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Acute Respiratory Failure ◽

Survival Prediction ◽

Membrane Oxygenation

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It's Not Just the Prices: Comparative Costs of Intensive Care Delivery for Acute Respiratory Failure Requiring Extracorporeal Membrane Oxygenation in Three Large International Centres

SSRN Electronic Journal ◽

10.2139/ssrn.3669145 ◽

2020 ◽

Author(s):

Vin Pellegrino ◽

Marc Pineton de Chambrun ◽

Jonathan Warsh ◽

Meredith Young ◽

Erik Dong ◽

...

Keyword(s):

Intensive Care ◽

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Acute Respiratory Failure ◽

Care Delivery ◽

Membrane Oxygenation

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Evaluation of Bivalirudin as the Primary Anticoagulant in Patients Receiving Extracorporeal Membrane Oxygenation for SARS-CoV-2–Associated Acute Respiratory Failure

Annals of Pharmacotherapy ◽

10.1177/10600280211036151 ◽

2021 ◽

pp. 106002802110361

Author(s):

Brittany D. Bissell ◽

Taylor Gabbard ◽

Erica A. Sheridan ◽

Maher A. Baz ◽

George A. Davis ◽

...

Keyword(s):

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Acute Respiratory Failure ◽

Retrospective Chart Review ◽

Venous Thromboembolic Event ◽

Membrane Oxygenation ◽

Published Report ◽

Starting Dose ◽

Venous Thromboembolic ◽

Polymerase Chain

Background Extracorporeal membrane oxygenation (ECMO) is a potential option for the management of severe acute respiratory failure secondary to COVID-19. Conflicting the use of this therapy is the known coagulopathy within COVID-19, leading to an incidence of venous thrombotic events of 25% to 49%. To date, limited guidance is available on optimal anticoagulation strategies in this population. Objective The purpose of this study was to evaluate the utilization of a pharmacist-driven bivalirudin dosing protocol for anticoagulation in the setting of ECMO for COVID-19–associated respiratory failure. Methods This was a single-center retrospective chart review over a 9-month period of patients receiving bivalirudin while on ECMO. All patients with acute respiratory failure requiring ECMO with a positive SARS-CoV-2 polymerase chain reaction were included. Bivalirudin was dosed via aPTT monitoring after a starting dose of 0.2 or 0.3 mg/kg/h. Results There were 33 patients included in this study, all receiving mechanical ventilation. The most common starting dose of bivalirudin was 0.2 mg/kg/h, with an average time to therapeutic range of 20 hours. Compared to previous reports, rates of bleeding were low at 15.1%, and 6.1% of patients developed a new venous thromboembolic event while on ECMO. ECMO survival was 51.5%, with an ICU mortality rate of 48.5%. Conclusion and Relevance In the first published report of its use within this population, bivalirudin was found to be a viable choice for anticoagulation in those patients on ECMO for severe respiratory failure secondary to COVID-19.

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