Usefulness of the RESP, PRESERVE, and ECMOnet scores for extracorporeal membrane oxygenation in children with acute respiratory distress syndrome

Won Kee Ahn; Jung Ho Han; Yoon Hee Kim; In Suk Sol; Seo Hee Yoon; Min Jung Kim; Kyung Won Kim; Myung Hyun Sohn; Kyu-Earn Kim

doi:10.4168/aard.2017.5.3.141

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Ahn, Han, Kim, Sol, Yoon, Kim, Kim, Sohn, and Kim: Usefulness of the RESP, PRESERVE, and ECMOnet scores for extracorporeal membrane oxygenation in children with acute respiratory distress syndrome

Original Article

Allergy Asthma Respir Dis 2017;5(3):141-146.

Published online: 5 May 2017

DOI: https://doi.org/10.4168/aard.2017.5.3.141

Usefulness of the RESP, PRESERVE, and ECMOnet scores for extracorporeal membrane oxygenation in children with acute respiratory distress syndrome

Won Kee Ahn, Jung Ho Han, Yoon Hee Kim, In Suk Sol, Seo Hee Yoon, Min Jung Kim, Kyung Won Kim, Myung Hyun Sohn, Kyu-Earn Kim

Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea

Correspondence to: Kyung Won Kim https://orcid.org/0000-0003-4529-6135 Department of Pediatrics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-2050, Fax: +82-2-393-9118, E-mail: KWKIM@yuhs.ac

Received 5 September 201624 October 2016 Accepted 15 December 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

With increasing use of extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS) in children, development of standardized strategies for survival prediction has become crucial; however, this has not been accom-plished yet. We evaluated the adult scoring systems for survival prediction used for their applicability in pediatric ARDS and validated them.

Methods

A total of 11 children with ARDS receiving ECMO from 2013 to 2014 were evaluated with adult scoring systems, including the Respiratory Extracorporeal-membrane-oxygenation Survival Prediction (RESP), the PRedicting dEath for SEvere ARDS on VV-ECMO (PRESERVE), and the ECMOnet scores. We compared the scores on these scales and the clinical characteristics between survivors and nonsurvivors.

Results

Eight of the 11 children died (72.7%). The PRESERVE score (survivors vs. nonsurvivors: 2 vs. 5.25, P=0.048), and the ECMOnet score (4.1 vs. 5.63, P=0.048) were lower in survivors than in nonsurvivors. They correctly predicted mortality prediction. There was no significant difference in the RESP score between survivors and non-survivors (-4.33 vs. -2.62, P =0.63). The parameters that showed significant differences in this study were peak inspiratory pressure, platelet, and delta neutrophil index. All children who were under immunocompromised conditions, such as those with tumors, or underwent hematopoietic stem cell transplantation died. The immunocompromised status should be considered an important factor for survival prediction in children with ARDS.

Conclusion

This is the first pilot study to apply the survival prediction scoring system to pediatric ARDS with ECMO. It is necessary to establish and modify the survival prediction score system for pediatric ARDS with ECMO.

Keywords: Extracorporeal membrane oxygenation, Acute respiratory distress syndrome, Survival, Child

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Table 1.

Clinical characteristics between the survivors and nonsurvivors

Characteristic	All patients (n=11)	Survival
Characteristic	All patients (n=11)	Survivors (n=3)	Nonsurvivors (n=8)
Age (yr)	4.8 (0.6–16.4)	1.9 (1.3–2.2)	5.8 (0.6–16.4)
Male sex	7 (63)	2 (66)	5 (63)
Body mass index (kg/m²)	15.5 (12.5–20.1)	15.2 (14.8–15.8)	15.4 (12.5–20.1)
Main causes of ARDS
Bacterial pneumonia	1 (9)	0 (0)	1 (13)
Viral pneumonia	4 (36)	1 (33)	3 (38)
Aspiration pneumonitis	1 (9)	1 (33)	0 (0)
Asthma	1 (9)	0 (0)	1 (13)
Others^†	4 (36)	1 (33)	3 (38)
Underlying disease
Immunocompromised	5 (45)	0 (0)	5 (62)
CNS dysfunction	6 (55)	3 (100)	3 (38)
Bacterial sepsis	1 (9)	0 (0)	1 (13)
Nonpulmonary infection^‡	7 (64)	1 (33)	6 (75)
Mean arterial pressure	56.5 (34–90)	49 (34–71)	59.3 (35–90)
Cardiac arrest	7 (64)	2 (67)	5 (63)
Laboratory data
WBC (/μL)	12,948 (390–32,100)	15,613 (5,640–27,950)	11,949 (390–32,100)
Platelet (×10³/μL)∗	164 (23–555)	332 (123–555)	101 (23–269)
Delta neutrophil count (%)∗	12.6 (0–47.1)	1.1 (0–3.2)	17.0 (1.1–47.1)
Bilirubin (mg/dL)	10.8 (0.1–2.7)	0.2 (0.1–0.3)	1.4 (0.3–2.7)
Creatinine (mg/dL)	0.46 (0.2–1.05)	0.24 (0.2–0.33)	0.55 (0.2–1.05)
Hematocrit (%)	27.9 (17–36)	33.0 (28.6–36)	26.0 (17–31.8)

Values are presented as median (interquartile range) or number (%).

ARDS, acute respiratory distress syndrome; CNS, central nervous system; WBC, white blood cell.

^∗ P<0.05 survivors vs. nonsurvivors.

^† Others are postpneumonectomy syndrome, pulmonary hemorrhage and 2 cases of lung graft-versus-host disease.

^‡ Nonpulmonary infection is defined as another fungal, bacterial or viral infection confirmed through blood sample that did not involve the lung.

Table 2.

Comparison of the scoring systems between survivors and nonsurvivors

Score	All patients (n=11)	Survival
Score	All patients (n=11)	Survivors (n=3)	Nonsurvivors (n=8)
ECMOnet score∗	5.5 (2.8–6.5)	4.5 (2.8–5)	5.5 (4.5–6.5)
PRESERVE score∗	4.4 (0–8)	2 (0–3)	5.3 (3–8)
RESP score	-3.1 (-8 to 4)	-4.3 (-6 to -2)	-2.6 (-8 to 4)

Values are presented as median (interquartile range).

ECMO, extracorporeal membrane oxygenation; PRESERVE score, PRedicting dEath for SEvere score; RESP score, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction score.

^∗ P<0.05 survivors vs. nonsurvivors

Table 3.

Comparison of each item for the PRESERVE, RESP, ECMOnet scores between survivors and nonsurvivors

Variable	All patients (n=11)	Survival
Variable	All patients (n=11)	Survivors (n=3)	Non-survivors (n=8)
Pre-ECMO rescue therapy
NM blockade agents	8 (73)	3 (100)	5 (63)
Prone position	2 (18)	1 (33)	1 (13)
Systemic steroids	11 (100)	3 (100)	8 (100)
Bicarbonate infusion	11 (100)	3 (100)	8 (100)
Interval MV-ECMO (day)	1.0 (0.3–27.0)	0.3 (0.3–1.8)	0.8 (0.3–27.0)
Pre-ECMO ventilator settings
PaO₂ /FiO₂	120.1 (40–232)	151.4 (69–290.3)	108.4 (40–256)
FiO2	0.9 (0.6–1.0)	0.9 (0.6–1.0)	0.9 (0.6–1.0)
PIP (cmH₂ O)∗	32.1 (19–40)	25.7 (19–30)	34.5 (26–40)
MAP (cmH2 O)	16.7 (11.7–21.5)	13.0 (11.7–16.7)	11.7 (11.9–21.5)
PEEP (cmH₂ O)	9 (5–15)	6 (5–10)	10 (5–15)
Pre-ECMO Gas study
PaCO₂ (mmHg)	56.1 (22–90)	43 (22–67)	61 (28–90)
PaO2 (mmHg)	97 (40–232)	132 (69–232)	85 (40–128)
Oxygenation index	17.8 (4.0–53)	13.7 (4.0–24.2)	24.2 (6–53)
Oxygen saturation index	19.0 (8–28.3)	15.3 (10.1–19.0)	13.0 (8.0–28.3)
Duration of ECMO support (day)	12.2 (4–40)	7.7 (6–10)	18 (4–40)

Values are presented as number (%) or median (interquartile range).

PRESERVE score, PRedicting dEath for SEvere score; RESP score, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction score; ECMO, extracorporeal membrane oxygenation; NM blockade, neuromuscular blockade; Interval MV-ECMO, duration of mechanical ventiliation before extracorporeal membrane oxygenation; PIP, peak inspiratory pressure; MAP, mean airway pressure; PEEP, positive end-expiratory pressure.

^∗ P<0.05 survivors vs. nonsurvivors.

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