Extracorporeal membrane oxygenation survival: External validation of current predictive scoring systems focusing on influenza A etiology

Abstract

Background 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. Research Question Finding the best scoring system for Influenza A ARDS ECMO success prediction. Study Design and Methods 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, divided into two groups: IVA and n‐IVA etiologies. Parameters collected within 24 h before ECMO initiation were used to calculate PRESERVE, RESP, PRESET, ECMOnet, Roch, and APACHE II scores. Results Compared to the IVA group, the n‐IVA group exhibited significantly higher ICU, 28‐day, and 6‐month mortality (p = 0.043, 0.034, and 0.047, 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) Conclusions 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.