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Volume 11
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10.3390/membranes11020084
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Article

Validation of Prognostic Scores in Extracorporeal Life Support: A Multi-Centric Retrospective Study

by
Christoph Fisser
1,*,†,
Luis Alberto Rincon-Gutierrez
2,†,
Tone Bull Enger
3,
Fabio Silvio Taccone
2,
Lars Mikael Broman
4,5,
Mirko Belliato
6,
Leda Nobile
2,
Federico Pappalardo
7,8 and
Maximilian V. Malfertheiner
1
1
Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany
2
Department of Intensive Care Medicine, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, B-1070 Brussels, Belgium
3
Clinic of Cardiology, St. Olavs University Hospital, 7030 Trondheim, Norway
4
ECMO Centre Karolinska, Karolinska University Hospital, 171 64 Stockholm, Sweden
5
Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden
6
UOS Advanced Respiratory Intensive Care Unit, UOC Anestesia e Rianimazione 1, Fondazione I.R.C.C.S. Policlinico San Matteo, 27100 Pavia, Italy
7
San Raffaele Scientific Institute, Vita Salute University, 20132 Milan, Italy
8
Department of Anesthesia and Intensive Care, IRCCS ISMETT, UPMC Italy, 90133 Palermo, Italy
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Membranes 2021, 11(2), 84; https://doi.org/10.3390/membranes11020084
Submission received: 28 December 2020 / Revised: 15 January 2021 / Accepted: 20 January 2021 / Published: 24 January 2021
(This article belongs to the Special Issue Advances in Extracorporeal Membrane Oxygenation)
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Abstract

Multiple prognostic scores have been developed for both veno-arterial (VA) and veno-venous (VV) extracorporeal membrane oxygenation (ECMO), mostly in single-center cohorts. The aim of this study was to compare and validate different prediction scores in a large multicenter ECMO-population. Methods: Data from five ECMO centers included 300 patients on VA and 329 on VV ECMO support (March 2008 to November 2016). Different prognostic scores were compared between survivors and non-survivors: APACHE II, SOFA, SAPS II in all patients; SAVE, modified SAVE and MELD-XI in VA ECMO; RESP, PRESET, ROCH and PRESERVE in VV ECMO. Model performance was compared using receiver-operating-curve analysis and assessment of model calibration. Survival was assessed at intensive care unit discharge. Results: The main indication for VA ECMO was cardiogenic shock; overall survival was 51%. ICU survivors had higher Glasgow Coma Scale scores and pH, required cardiopulmonary resuscitation (CPR) less frequently, had lower lactate levels and shorter ventilation time pre-ECMO at baseline. The best discrimination between survivors and non-survivors was observed with the SAPS II score (area under the curve [AUC] of 0.73 (95% CI 0.67–0.78)). The main indication for VV ECMO was pneumonia; overall survival was 60%. Lower PaCO2, higher pH, lower lactate and lesser need for CPR were observed among survivors. The best discrimination between survivors and non-survivors was observed with the PRESET score (AUC 0.66 (95% CI 0.60–0.72)). Conclusion: The prognostic performance of most scores was moderate in ECMO patients. The use of such scores to decide about ECMO implementation in potential candidates should be discouraged.
Keywords: ECMO; score; RESP score; SAVE score; validation; ECLS ECMO; score; RESP score; SAVE score; validation; ECLS

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MDPI and ACS Style

Fisser, C.; Rincon-Gutierrez, L.A.; Enger, T.B.; Taccone, F.S.; Broman, L.M.; Belliato, M.; Nobile, L.; Pappalardo, F.; Malfertheiner, M.V. Validation of Prognostic Scores in Extracorporeal Life Support: A Multi-Centric Retrospective Study. Membranes 2021, 11, 84. https://doi.org/10.3390/membranes11020084

AMA Style

Fisser C, Rincon-Gutierrez LA, Enger TB, Taccone FS, Broman LM, Belliato M, Nobile L, Pappalardo F, Malfertheiner MV. Validation of Prognostic Scores in Extracorporeal Life Support: A Multi-Centric Retrospective Study. Membranes. 2021; 11(2):84. https://doi.org/10.3390/membranes11020084

Chicago/Turabian Style

Fisser, Christoph, Luis Alberto Rincon-Gutierrez, Tone Bull Enger, Fabio Silvio Taccone, Lars Mikael Broman, Mirko Belliato, Leda Nobile, Federico Pappalardo, and Maximilian V. Malfertheiner. 2021. "Validation of Prognostic Scores in Extracorporeal Life Support: A Multi-Centric Retrospective Study" Membranes 11, no. 2: 84. https://doi.org/10.3390/membranes11020084

APA Style

Fisser, C., Rincon-Gutierrez, L. A., Enger, T. B., Taccone, F. S., Broman, L. M., Belliato, M., Nobile, L., Pappalardo, F., & Malfertheiner, M. V. (2021). Validation of Prognostic Scores in Extracorporeal Life Support: A Multi-Centric Retrospective Study. Membranes, 11(2), 84. https://doi.org/10.3390/membranes11020084

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