Comparison of mortality prediction models in acute respiratory distress syndrome undergoing extracorporeal membrane oxygenation and development of a novel prediction score: the PREdiction of Survival on ECMO Therapy-Score (PRESET-Score)

It remains unclear to what extent the outcomes and complications of extracorporeal membrane oxygenation (ECMO) therapy in COVID-19 patients with acute respiratory distress syndrome (ARDS) differ from non-COVID-19 ARDS patients. In an observational, propensity-matched study, outcomes after ECMO support were compared between 19 COVID-19 patients suffering from ARDS (COVID group) and 34 matched non-COVID-19 ARDS patients (NCOVID group) from our historical cohort. A 1:2 propensity matching was performed based on respiratory ECMO survival prediction (RESP) score, age, gender, bilirubin, and creatinine levels. Patients’ characteristics, laboratory parameters, adverse events, and 90-day survival were analyzed. Patients’ characteristics in COVID and NCOVID groups were similar. Before ECMO initiation, fibrinogen levels were significantly higher in the COVID group (median: 493 vs. 364 mg/dL, p < 0.001). Median ECMO support duration was similar (16 vs. 13 days, p = 0.714, respectively). During ECMO therapy, patients in the COVID group developed significantly more thromboembolic events (TEE) than did those in the NCOVID group (42% vs. 12%, p = 0.031), which were mainly pulmonary artery embolism (PAE) (26% vs. 0%, p = 0.008). The rate of major bleeding events (42% vs. 62%, p = 0.263) was similar. Fibrinogen decreased significantly more in the COVID group than in the NCOVID group (p < 0.001), whereas D-dimer increased in the COVID group (p = 0.011). Additionally, 90-day mortality did not differ (47% vs. 74%; p = 0.064) between COVID and NCOVID groups. Compared with that in non-COVID-19 ARDS patients, ECMO support in COVID-19 patients was associated with comparable in-hospital mortality and similar bleeding rates but a higher incidence of TEE, especially PAE. In contrast, coagulation parameters differed between COVID and NCOVID patients.

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Analysis of extracorporeal membrane oxygenation in trauma patients with acute respiratory distress syndrome: A case series

The International Journal of Artificial Organs ◽

10.1177/0391398820980736 ◽

2021 ◽

pp. 039139882098073

Author(s):

Friederike Weidemann ◽

Sebastian Decker ◽

Jelena Epping ◽

Marcus Örgel ◽

Christian Krettek ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Extracorporeal Membrane Oxygenation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Sofa Score ◽

Thoracic Trauma ◽

Distress Syndrome ◽

Case Series ◽

Polytrauma Patients ◽

Ecmo Therapy

Background: Thoracic trauma is the most common injury in polytrauma patients. Often associated with the development of an acute respiratory distress syndrome (ARDS), conservative treatment options are very restricted and reach their limits quickly. Objective: Extracorporeal membrane oxygenation (ECMO) is a wellestablished therapy in cardio-thoracic surgery and internal medicine intensive care units. The purpose of this study is to analyse the potential benefit of ECMO therapy in ARDS treatment in polytrauma patients. Design: Retrospective case series. Setting: Level 1 trauma centre, Germany, 04/2011-04/2019. Patients: Nineteen patients with ARDS treated with a veno-venous ECMO system. Main outcome measures: This study focused on the time leading to therapy initiation, the severity of thoracic and overall injury. The Sequential Organ Failure Assessment (SOFA) Score, the Murray Score, the Abbreviated Injury Scale (AIS) 2005 level and the Injury Severity Score (ISS) were analysed. The results were analysed regarding survival and death. Results: The survival rate was 53%. The ISS was the same for survivors and deceased patients ( p = 0.604). Early initiation of ECMO therapy showed a significant trend for survivors ( p = 0.071). The SOFA Score level before ECMO therapy was significantly lower in the survivors than in those who died ( p = 0.035). The AISThorax level for survivors showed a significantly higher score level than the one for deceased patients ( p = 0.05). Conclusion: ECMO therapy in polytrauma patients is a safe and effective option, in particular when used early in ARDS treatment. The overall severity of organ failure determined the likelihood of survival rather than the thoracic trauma itself.

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Outcomes and survival prediction models for severe adult acute respiratory distress syndrome treated with extracorporeal membrane oxygenation

Critical Care ◽

10.1186/s13054-016-1568-y ◽

2016 ◽

Vol 20 (1) ◽

Cited By ~ 33

Author(s):

Sacha Rozencwajg ◽

David Pilcher ◽

Alain Combes ◽

Matthieu Schmidt

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Extracorporeal Membrane Oxygenation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Prediction Models ◽

Survival Prediction ◽

Membrane Oxygenation

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Early Driving Pressure Changes Predict Outcomes during Venovenous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome

Critical Care Research and Practice ◽

10.1155/2020/6958152 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Harry Magunia ◽

Helene A. Haeberle ◽

Philipp Henn ◽

Martin Mehrländer ◽

Peer O. Vlatten ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Propensity Score ◽

Extracorporeal Membrane Oxygenation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Patient Characteristics ◽

Driving Pressure ◽

Pressure Changes ◽

Ecmo Therapy

Background. Extracorporeal membrane oxygenation (ECMO) serves as a rescue therapy when systemic hypoxia persists despite conventional care for severe acute respiratory distress syndrome (ARDS). Due to the extracorporeal gas exchange, the paO2/FiO2 ratio cannot be used as the primary marker for disease severity and progression. Therefore, we performed a propensity score-matched analysis to identify other potential predictors of outcomes in patients supported by ECMO therapy. Results. Between December 2014 and May 2018, 105 patients underwent venovenous ECMO in our institution. From these patients, we identified 28 who died during ECMO therapy and assigned 28 control patients using propensity score matching based on the following criteria: age, ARDS severity, and SAPSII score at admission. A statistical evaluation of the patient characteristics, intensive care data, morbidities, respiratory system variables, and outcomes was performed. The baseline patient characteristics did not differ between groups and ECMO was placed on day 1 in all patients. The analyzed variables of respiratory mechanics, such as the plateau pressure, positive end-expiratory pressure, and tidal volume, did not differ between groups. The driving pressure before ECMO was equal between the nonsurvivors and the controls. Twelve hours after initiation of ECMO therapy, the driving pressure decreased by 40.8% in the survivors but by only 20.1% in the nonsurvivors. Conclusions. We report that very early driving pressure changes can serve as an indicator of disease severity and predict patient survival following ECMO therapy.

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Extracorporeal membrane oxygenation for acute respiratory distress syndrome in burn patients: a case series and literature update

Burns & Trauma ◽

10.1186/s41038-019-0166-z ◽

2019 ◽

Vol 7 ◽

Author(s):

Mehran Dadras ◽

Johannes M. Wagner ◽

Christoph Wallner ◽

Julika Huber ◽

Dirk Buchwald ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Extracorporeal Membrane Oxygenation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Case Series ◽

Outcome Data ◽

Burn Patients ◽

Membrane Oxygenation ◽

Ecmo Therapy

Abstract Background Acute respiratory distress syndrome (ARDS) has a reported incidence of 34–43% in ventilated burn patients and is associated with a mortality of 59% in the severe form. The use and experience with extracorporeal membrane oxygenation (ECMO) in burn patients developing ARDS are still limited. We present our results and discuss the significance of ECMO in treating burn patients. Methods A retrospective analysis of burn patients treated with ECMO for ARDS between January 2017 and January 2019 was performed. Demographic, clinical, and outcome data were collected and analyzed. Results Eight burn patients were treated at our institution with ECMO in the designated time period. Of these, all but one patient had inhalation injury, burn percentage of TBSA was 37 ± 23%, ABSI score was 8.4 ± 2, and R-Baux-score was 98 ± 21. Seven patients developed severe ARDS and one patient moderate ARDS according to the Berlin classification with a PaO2/FiO2 ratio upon initiation of ECMO therapy of 62 ± 22 mmHg. ECMO duration was 388 ± 283 h. Three patients died from severe sepsis while five patients survived to hospital discharge. Conclusions ECMO is a viable therapy option in burn patients developing severe ARDS and can contribute to survival rates similar to ECMO therapy in non-burn-associated severe ARDS. Consequently, patients with severe respiratory insufficiency with unsuccessful conventional treatment and suspected worsening should be transferred to burn units with the possibility of ECMO treatment to improve outcome.

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