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Predicting Mortality in ARDS Patients Treated with ECMO

Summary and Comment |
November 14, 2013

Predicting Mortality in ARDS Patients Treated with ECMO

  1. Kristi L. Koenig, MD, FACEP, FIFEM

Composite score based on age, sequential organ failure assessment score, and influenza diagnosis predicts mortality risk.

  1. Kristi L. Koenig, MD, FACEP, FIFEM

Definitive criteria are lacking for initiation of extracorporeal membrane oxygenation (ECMO) in patients with acute respiratory distress syndrome (ARDS). To identify predictors of mortality in such patients, researchers at a referral center in France prospectively analyzed data from 85 consecutive ARDS patients retrieved from referring hospitals for ECMO treatment during a 3.5-year period. Patients aged >70 with chronic heart, lung, or kidney disease, or with sequential organ failure assessment (SOFA) scores >18 were excluded.

Patients had severe hypoxia and respiratory acidosis (PaCO2 >70 mm Hg; pH <7.2). ARDS etiologies included community-acquired bacterial pneumonia (35%), influenza pneumonia (23%), and nosocomial pneumonia (14%). More than half the patients (56%) died in hospital. Age, SOFA score before ECMO, and diagnosis of influenza were independently associated with hospital mortality. Using logistic regression analysis of these three parameters, investigators derived a score (range, 0–4) to predict the probability of hospital mortality after ECMO initiation: Probabilities were 40% in patients with scores of 0–2 and 93% in patients with scores of 3–4. A diagnosis of influenza pneumonia and SOFA score <12 before ECMO portended the best prognosis (22% mortality).

Comment

These data can guide physicians regarding when to consider initiating extracorporeal membrane oxygenation — an expensive salvage therapy for rare cases of refractory hypoxia or acidosis that is not available at many hospitals. Discussion with the ECMO team consultant can help determine when ECMO should be used, and when to transfer patients for this higher level of care.

  • Disclosures for Kristi L. Koenig, MD, FACEP, FIFEM at time of publication Grant / research support State of California Editorial boards Koenig & Schultz's Disaster Medicine: Comprehensive Principles and Practices Leadership positions in professional societies World Association of Disaster and Emergency Medicine (Board of Directors)

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