Predicting Survival after Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Failure: The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) Score
Predicting Survival after Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Failure: The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) Score
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DOI：
10.1164/rccm.201311-2023oc
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发表时间：
2014-06-01
影响因子：
24.7
通讯作者：
Pilcher, David
中科院分区：
文献类型：
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作者：
Schmidt, Matthieu;Bailey, Michael;Pilcher, David
基本原理：越来越多地使用体外膜氧合（ECMO）治疗急性呼吸衰竭可能会增加资源需求和医院成本。更好地预测这些患者的生存率可能会改善资源利用，允许对中心特定结局进行风险调整比较，并帮助临床医生锁定最有可能从ECMO中获益的患者。目的：建立一个模型，用于预测呼吸衰竭患者开始ECMO时的住院生存率。从体外生命支持组织（ELSO）国际登记研究中提取了2000年至2012年接受ECMO治疗的严重急性呼吸衰竭成人患者。多变量逻辑回归被用来创建呼吸ECMO生存预测（RESP）score使用bootstrapping methodorogy与内部和外部validation. Measures和主要结果：纳入研究的2,355例患者中，1,338例（57%）从医院活着出院。RESP评分是使用与住院生存率独立相关的ECMO前变量进行logistic回归，包括年龄、免疫功能低下状态、ECMO前机械通气持续时间、诊断、中枢神经系统功能障碍、急性相关非肺部感染、神经肌肉阻滞剂或一氧化氮使用、碳酸氢盐输注、心脏骤停、Pa-CO2和吸气峰压。RESP评分的受试者工作特征曲线分析为c = 0.74（95%置信区间，0.72-0.76）。外部验证，对140例患者进行，表现出良好的歧视（c = 0.92; 95%置信区间，0.89-0.97）。结论：RESP评分是一个相关的和有效的工具，以预测患者接受ECMO呼吸衰竭的生存。
Rationale: Increasing use of extracorporeal membrane oxygenation (ECMO) for acute respiratory failure may increase resource requirements and hospital costs. Better prediction of survival in these patients may improve resource use, allow risk-adjusted comparison of center-specific outcomes, and help clinicians to target patients most likely to benefit from ECMO.Objectives: To create a model for predicting hospital survival at initiation of ECMO for respiratory failure.Methods: Adult patients with severe acute respiratory failure treated by ECMO from 2000 to 2012 were extracted from the Extracorporeal Life Support Organization (ELSO) international registry. Multivariable logistic regression was used to create the Respiratory ECMO Survival Prediction (RESP) score using bootstrapping methodorogy with internal and external validation.Measurements and Main Results: Of the 2,355 patients included in the study, 1,338 patients (57%) were discharged alive from hospital. The RESP score was developed using pre-ECMO variables independently associated with hospital survival on logistic regression, which included age, immunocompromised status, duration of mechanical ventilation before ECMO, diagnosis, central nervous system dysfunction, acute associated nonpulmonary infection, neuromuscular blockade agents or nitric oxide use, bicarbonate infusion, cardiac arrest, Pa-CO2, and peak inspiratory pressure. The receiver operating characteristics Curve analysis of the RESP score was c = 0.74 (95% confidence interval, 0.72-0.76). External validation, performed on 140 patients, exhibited excellent discrimination (c = 0.92; 95% confidence interval, 0.89-0.97).Conclusions: The RESP score is a relevant and validated tool to predict survival for patients receiving ECMO for respiratory failure.