Schmidt et al reported the PRESERVE (Predicting death for severe ARDS on VV-ECMO) risk score. This can predict the outcome following the use of extracorporeal membrane oxygenation to treated a patient with severe adult respiratory distress syndrome (ARDS). The authors are from Universite Pierre et Marie Curie, Universite de Picardie Jules Verne, and Universite de Bordeaux in France.
Patient selection: severe ARDS treated with ECMO (primarily venovenous)
Parameters:
(1) age in years
(2) body mass index (BMI)
(3) immunocompromised status (hematologic malignancy, solid tumor, solid organ transplantation, corticosteroid therapy high-dose or long-term, immunosuppression, HIV infection)
(4) SOFA score
(5) number of days on mechanical ventilation
(6) prone positioning before ECMO
(7) PEEP in cm H2O
(8) plateau pressure in cm H2O
|
Parameter |
Finding |
Points |
|
age in years |
< 45 years of age |
0 |
|
|
45 to 55 years |
2 |
|
|
> 55 years |
3 |
|
BMI |
<= 30 kg per sq meter |
0 |
|
|
> 30 |
-2 |
|
immunocompromised |
no |
0 |
|
|
yes |
2 |
|
SOFA |
<= 12 |
0 |
|
|
> 12 |
1 |
|
mechanical ventilations |
<= 6 days |
0 |
|
|
> 6 days |
1 |
|
prone positioning before ECMO |
no |
1 |
|
|
yes |
0 |
|
PEEP |
< 10 cm H2O |
2 |
|
|
>= 10 |
0 |
|
plateau pressure |
<= 30 cm H2O |
0 |
|
|
> 30 cm H2O |
2 |
total score =
= MAX(0, SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 12 (paper states 14)
• The higher the score the worse the long-term survival.
|
Total Score |
6 Month Survival |
|
0 to 2 |
97% |
|
3 or 4 |
79% |
|
5 or 6 |
54% |
|
>= 7 |
16% |
Specialty: Critical Care, Emergency Medicine
