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

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. 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. 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)). 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.

SUBMITTER: Fisser C

PROVIDER: S-EPMC7912316 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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

Fisser Christoph C Rincon-Gutierrez Luis Alberto LA Enger Tone Bull TB Taccone Fabio Silvio FS Broman Lars Mikael LM Belliato Mirko M Nobile Leda L Pappalardo Federico F Malfertheiner Maximilian V MV

Membranes 20210124 2

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.<h4>Methods</h4>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: A ...[more]

PMID: 33498825

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Project description:ObjectivesAlthough there is a substantial published experience of extracorporeal membrane oxygenation during the H1N1 pandemic, less is known about the use of extracorporeal membrane oxygenation in patients with other subtypes of the influenza A virus. We hypothesized that the severity of illness and survival of patients supported with extracorporeal membrane oxygenation would differ for those with H1N1 influenza A compared with other subtypes of influenza A.Design setting patientsRetrospective study of extracorporeal membrane oxygenation-supported adults (> 18 yr) with influenza A viral infection reported to the Extracorporeal Life Support Organization Registry between 2009 and 2019. We describe the frequency and compare characteristics and factors associated with in-hospital survival using a least absolute shrinkage and selection operator regression analysis.Main outcomes and measuresOf 2,461 patients supported with extracorporeal membrane oxygenation for influenza A, 445 had H1N1, and 2,004 had other subtypes of influenza A. H1N1 was the predominant subtype between 2009 and 2011. H1N1 patients were younger, with more severe illness at extracorporeal membrane oxygenation cannulation and higher reported extracorporeal membrane oxygenation complications than those with other influenza A subtypes. Patient characteristics including younger age and higher weight and patient management characteristics including longer ventilation duration before extracorporeal membrane oxygenation were associated with worse survival. Extracorporeal membrane oxygenation complications were associated with reduced survival. There was no difference in survival to hospital discharge according to influenza subtype after adjusting for other characteristics.ConclusionsPatients supported with extracorporeal membrane oxygenation for H1N1 were younger, with more severe illness than those supported for other influenza A subtypes. Survival to hospital discharge was associated with patient characteristics, management characteristics, and extracorporeal membrane oxygenation complications but was not impacted by the specific influenza A subtype.

Project description:BackgroundMultiple major health organisations recommend the use of extracorporeal membrane oxygenation (ECMO) support for COVID-19-related acute hypoxaemic respiratory failure. However, initial reports of ECMO use in patients with COVID-19 described very high mortality and there have been no large, international cohort studies of ECMO for COVID-19 reported to date.MethodsWe used data from the Extracorporeal Life Support Organization (ELSO) Registry to characterise the epidemiology, hospital course, and outcomes of patients aged 16 years or older with confirmed COVID-19 who had ECMO support initiated between Jan 16 and May 1, 2020, at 213 hospitals in 36 countries. The primary outcome was in-hospital death in a time-to-event analysis assessed at 90 days after ECMO initiation. We applied a multivariable Cox model to examine whether patient and hospital factors were associated with in-hospital mortality.FindingsData for 1035 patients with COVID-19 who received ECMO support were included in this study. Of these, 67 (6%) remained hospitalised, 311 (30%) were discharged home or to an acute rehabilitation centre, 101 (10%) were discharged to a long-term acute care centre or unspecified location, 176 (17%) were discharged to another hospital, and 380 (37%) died. The estimated cumulative incidence of in-hospital mortality 90 days after the initiation of ECMO was 37·4% (95% CI 34·4-40·4). Mortality was 39% (380 of 968) in patients with a final disposition of death or hospital discharge. The use of ECMO for circulatory support was independently associated with higher in-hospital mortality (hazard ratio 1·89, 95% CI 1·20-2·97). In the subset of patients with COVID-19 receiving respiratory (venovenous) ECMO and characterised as having acute respiratory distress syndrome, the estimated cumulative incidence of in-hospital mortality 90 days after the initiation of ECMO was 38·0% (95% CI 34·6-41·5).InterpretationIn patients with COVID-19 who received ECMO, both estimated mortality 90 days after ECMO and mortality in those with a final disposition of death or discharge were less than 40%. These data from 213 hospitals worldwide provide a generalisable estimate of ECMO mortality in the setting of COVID-19.FundingNone.

Project description:BackgroundSerious games enrich simulation-based health care trainings and improve knowledge, skills, and self-confidence of learners while entertaining them.ObjectiveA platform which can combine performance data from a basic life support (BLS) serious game app and hands-on data based on the same scoring system is not available in the market. The aim of this study was to create such a platform and investigate whether performance evaluation of BLS trainings would be more objective compared to conventional Objective Structured Clinical Examination (OSCE) examinations if these evaluations were carried out with the platform which combines OSCE scoring criteria with sensor data retrieved from the simulator's sensors.MethodsParticipants were 25 volunteers (11 men [44.0%] and 14 [56.0] women) among Ac?badem Mehmet Ali Ayd?nlar University students without prior knowledge of the BLS protocol. A serious game module has been created for teaching learners the European Resuscitation Council Basic Life Support 2015 protocol. A second module called the hands-on module was designed for educators. This module includes a checklist used for BLS OSCE examinations and can retrieve sensor data such as compression depth, compression frequency, and ventilation volume from the manikin (CPR Lilly; 3B Scientific GmbH) via Bluetooth. Data retrieved from the sensors of the manikin enable educators to evaluate learners in a more objective way. Performance data retrieved from the serious gaming module have been combined with the results of the hands-on module. Data acquired from the hands-on module have also been compared with the results of conventional OSCE scores of the participants, which were obtained by watching the videos of the same trainings.ResultsParticipants were considered successful in the game if they scored 80/100 or above. Overall, participants scored 80 or above in an average of 1.4 (SD 0.65) trials. The average BLS serious game score was 88.3/100 (SD 5.17) and hands-on average score was 70.7/100 (SD 17.3), whereas the OSCE average score was 84.4/100 (SD 12.9). There was no statistically significant correlation between success on trials (score ?80/100), serious game, hands-on training app, and OSCE scores (Spearman rho test, P>.05). The mean BLS serious game score of the participants was 88.3/100 (SD 5.17), whereas their mean hands-on training app score was 70.7/100 (SD 17.3) and OSCE score was 84.4/100 (SD 12.9).ConclusionsAlthough scoring criteria for OSCE and hands-on training app were identical, OSCE scores were 17% higher than hands-on training app scores. After analyzing the difference of scores between hands-on training app and OSCE, it has been revealed that these differences originate from scoring parameters such as compression depth, compression frequency, and ventilation volume. These data suggest that evaluation of BLS trainings would be more objective if these evaluations were carried out with the modality, which combines visual OSCE scoring criteria with sensor data retrieved from the simulator's sensors.Trial registrationClinicalTrials.gov NCT04533893; https://clinicaltrials.gov/ct2/show/NCT04533893.

Project description:In thoracic surgery, extracorporeal life support (ECLS) techniques are performed to (I) provide a short to mid term extracorporeal mechanical support; (II) realize the gas exchanges; and (III)-depending the configuration of the circuit-substitute the failed heart function. The objective of this review is to describe the rational of the different ECLS techniques used in thoracic surgery and lung transplantation (LTx) with a specific attention to the vascular access. Venovenous extracorporeal membrane oxygenation (VV ECMO) is the most common ECLS technique used in thoracic surgery and represents the best strategy to support the lung function. VV ECMO needs peripheral vascular access. The selection between his double-site or single-site configuration should be decided according the level of O2 requirements, the nosological context, and the interest to perform an ECLS ambulatory strategy. Venoarterial (VA) ECMO uses peripheral and/or central cannulation sites. Central VA ECMO is mainly used in LTx instead a conventional cardiopulmonary bypass (CPB) to decrease the risk of hemorrhagic issues and the rate of primary graft dysfunction (PGD). Peripheral VA ECMO is traditionally realized in a femoro-femoral configuration. Femoro-femoral VA ECMO allows a cardiocirculatory support but does not provide an appropriate oxygenation of the brain and the heart. The isolated hypercapnic failure is currently supported by extracorporeal CO2 removal (ECCO2R) devices inserted in jugular or subclavian veins. The interest of the Novalung (Novalung GmbH, Hechingen, Germany) persists due to his central configuration indicated to bridge to LTx patients suffering from pulmonary hypertension. The increasing panel of ECLS technologies available in thoracic surgery is the results of a century of clinical practices, engineering progress, and improvements of physiological knowledges. The selection of the ECLS technique-and therefore the vascular access to implant the device-for a given nosological context trends to be defined according an evidence-based medicine.

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

Publications

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

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