Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic.
Department of Anesthesiology, Perioperative, and Intensive Care Medicine, Krajská zdravotní, a.s., Ústi nad Labem, Czech Republic.
Artif Organs. 2021 Aug;45(8):881-892. doi: 10.1111/aor.13932. Epub 2021 Apr 19.
Despite increasing clinical experience with extracorporeal membrane oxygenation (ECMO), its optimal indications remain unclear. Here, we externally evaluated all currently available ECMO survival-predicting scoring systems and the APACHE II score in subjects undergoing veno-venous ECMO (VV ECMO) support due to acute respiratory distress syndrome (ARDS) with influenza (IVA) and non-influenza (n-IVA) etiologies. Our aim was to find the best scoring system for influenza A ARDS ECMO success prediction. Retrospective data were analyzed to assess the abilities of the PRESERVE, RESP, PRESET, ECMOnet, Roch, and APACHE II scores to predict patient outcome. Patients treated with veno-venous ECMO support for ARDS were divided into two groups: IVA and n-IVA etiologies. Parameters collected within 24 hours before ECMO initiation were used to calculate PRESERVE, RESP, PRESET, ECMOnet, Roch, and APACHE II scores. Compared to the IVA group, the n-IVA group exhibited significantly higher ICU, 28-day, and 6-month mortality (P = .043, .034, and .047, respectively). Regarding ECMO support success predictions, the area under the receiver operating characteristic curve (AUC) was 0.62 for PRESERVE, 0.44 for RESP, 0.57 for PRESET, and 0.67 for ECMOnet, and 0.62 for Roch calculated for all subjects according to the original papers. In the IVA group, APACHE II had the best predictive value for ICU, hospital, 28-day, and 6-month mortality (AUC values of 0.73, 0.73, 0.70, and 0.73, respectively). In the n-IVA group, APACHE II was the best predictor of survival in the ICU and hospital (AUC 0.54 and 0.57, respectively). From all possible ECMO survival scoring systems, the APACHE II score had the best predictive value for VV ECMO subjects with ARDS caused by influenza A-related pneumonia with a cut-off value of about 32 points.
尽管体外膜肺氧合（ECMO）的临床经验不断增加，但最佳适应证仍不明确。在这里，我们对所有目前可用的 ECMO 生存预测评分系统和急性呼吸窘迫综合征（ARDS）伴流感（IVA）和非流感（n-IVA）病因行静脉-静脉 ECMO（VV ECMO）支持的患者的急性生理学与慢性健康状况评分系统 II（APACHE II）评分进行了外部评估。我们的目的是找到预测甲型流感相关 ARDS 患者 ECMO 成功的最佳评分系统。回顾性数据分析用于评估 PRESERVE、RESP、PRESET、ECMOnet、Roch 和 APACHE II 评分预测患者结局的能力。接受 VV ECMO 支持治疗 ARDS 的患者分为 IVA 和 n-IVA 病因两组。在开始 ECMO 前 24 小时内收集的参数用于计算 PRESERVE、RESP、PRESET、ECMOnet、Roch 和 APACHE II 评分。与 IVA 组相比，n-IVA 组 ICU、28 天和 6 个月死亡率显著更高（分别为 P=0.043、0.034 和 0.047）。关于 ECMO 支持成功的预测，根据原始论文，PRESERVE、RESP、PRESET 和 ECMOnet 的受试者曲线下面积（AUC）分别为 0.62、0.44、0.57 和 0.67，Roch 为 0.62。在 IVA 组中，APACHE II 对 ICU、医院、28 天和 6 个月死亡率具有最佳预测价值（AUC 值分别为 0.73、0.73、0.70 和 0.73）。在 n-IVA 组中，APACHE II 是 ICU 和医院存活的最佳预测因子（AUC 为 0.54 和 0.57）。在所有可能的 ECMO 生存评分系统中，APACHE II 评分对由甲型流感相关肺炎引起的 ARDS 患者的 VV ECMO 具有最佳预测价值，截断值约为 32 分。
