Schmidt et al developed a score for predicting hospital mortality for a patient with the acute respiratory distress syndrome (ARDS) requiring therapy with extracorporeal membrane oxygenation (ECMO). This can help to identify a patient who may benefit from more aggressive management. The authors are from multiple hospitals in Australia, Europe and the United States.
Patient selection: ARDS started on ECMO, age >= 18 years
Parameters (known prior to initiation of ECMO):
(1) age in years
(2) immune status
(3) mechanical ventilation prior to initiation of ECMO
(4) respiratory diagnosis
(5) central nervous system (CNS) dysfunction
(6) acute nonpulmonary infection
(7) neuromuscular blockade agents before ECMO
(8) nitric oxide use before ECMO
(9) bicarbonate infusion before ECMO
(10) cardiac arrest before ECMO
(11) PaCO2 in mm Hg
(12) peak inspiratory pressure in cm H2O
|
Parameter |
Finding |
Points |
|---|---|---|
|
age in years |
18 to 49 years |
0 |
|
|
50 to 59 years |
-2 |
|
|
>= 60 years |
-3 |
|
immune status |
immune competent |
0 |
|
|
immunocompromised |
-2 |
|
mechanical ventilation |
< 48 hours |
3 |
|
|
48 hours to 7 days |
1 |
|
|
> 7 days |
0 |
|
respiratory diagnosis |
viral pneumonia |
3 |
|
|
bacterial pneumonia |
3 |
|
|
asthma |
11 |
|
|
trauma or burn |
3 |
|
|
aspiration pneumonia |
5 |
|
|
other acute respiratory |
1 |
|
|
chronic respiratory |
0 |
|
|
nonrespiratory diagnosis |
0 |
|
CNS dysfunction |
no |
0 |
|
|
yes |
-7 |
|
acute nonpulmonary infection |
no |
0 |
|
|
yes |
-3 |
|
neuromuscular blockade |
no |
0 |
|
|
yes |
1 |
|
nitric oxide use |
no |
0 |
|
|
yes |
-1 |
|
bicarbonate infusion |
no |
0 |
|
|
yes |
-2 |
|
cardiac arrest before ECMO |
no |
0 |
|
|
yes |
-2 |
|
PaCO2 |
< 75 mm Hg |
0 |
|
|
>= 75 mm Hg |
-1 |
|
peak inspiratory pressure |
< 42 cm H2O |
0 |
|
|
>=42 cm H2O |
-1 |
where:
• Immunocompromised = solid tumor, hematologic malignancy, solid organ transplant, HIV, or cirrhosis.
• CNS dysfunction = neurotrauma, stroke, encephalopathy, cerebral embolism, or seizure/epilepsy.
total score =
= SUM(points for all 12 parameters)
Interpretation:
• minimum score: -22
• maximum score: 15
• The higher the score the better the survival..
|
Score |
Risk Class |
Survival |
|---|---|---|
|
-22 to –6 |
V |
18% |
|
-5 to –2 |
IV |
33% |
|
-1 to 2 |
III |
57% |
|
3 to 5 |
II |
76% |
|
6 to 15 |
I |
92% |
Performance:
• The area under the ROC curve was 0.74.
Specialty: Critical Care, Emergency Medicine
