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. 2021 Jan 24;11(2):84.
doi: 10.3390/membranes11020084.

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

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 , Maximilian V Malfertheiner  1
Affiliations

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

Christoph Fisser et al. Membranes (Basel). .

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: ECLS; ECMO; RESP score; SAVE score; score; validation.

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Conflict of interest statement

F.S.T., L.M.B., M.B., F.P. and M.V.M. received consultancy fees from Eurosets (Medolla, Italy), M.B. received fees as a congress speaker from Hamilton Medical (Bonaduz, Swiss), L.M.B. received consultancy fees from Xenios AG (Heilbronn, Germany). All other authors have no conflicts of interests to declare.

Figures

Figure 1
Figure 1
Boxplot of prognostic score values in in patients supported with veno-arterial extracorporeal membrane oxygenation according to survivors and non-survivors. Data are expressed as median, minimum, maximum, 25. percentile, and 75. percentile.
Figure 2
Figure 2
Comparison of predicted and observed mortality rates in patients supported with veno-arterial extracorporeal membrane oxygenation.
Figure 3
Figure 3
Comparison of area under the receiver-operating characteristics curve (AUC) for (A) veno-arterial extracorporeal membrane oxygenation scores. Akaike and Bayesian Information Criterions (AIC and BIC, respectively).
Figure 4
Figure 4
Boxplot of prognostic score values in in patients supported with veno-venous extracorporeal membrane oxygenation according to survivors and non-survivors. Data are expressed as median, minimum, maximum, 25. percentile, and 75. percentile.
Figure 5
Figure 5
Comparison of predicted and observed mortality rates in patients supported with veno-venous extracorporeal membrane oxygenation.
Figure 6
Figure 6
Comparison of area under the receiver-operating characteristics curve (AUC) for veno-venous extracorporeal membrane oxygenation scores. Akaike and Bayesian Information Criterions (AIC and BIC, respectively).
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