Respiratory ECMO Survival Prediction (RESP) Score for COVID-19 Patients Treated with ECMO

Abstract

Veno-venous extracorporeal membrane oxygenation (VV ECMO) has been used as a life-supporting modality for patients with severe respiratory failure because of coronavirus disease 2019 (COVID-19). We aim to evaluate the performance of the RESP score in predicting the hospital survival of COVID-19 patients undergoing VV ECMO. We performed retrospective analysis of the extracorporeal life support organization (ELSO) dataset for COVID-19 patients requiring ECMO support to evaluate the performance of RESP score in predicting in hospital survival. All adult (age ≥18) COVID-19 patients receiving VV ECMO for acute respiratory failure enrolled in the ELSO database from March to August 2020 were included in the analysis. A total of 1985 patients from the ELSO registry were identified and analyzed based on pre-ECMO variables. Median RESP score of survivors was 3 (IQR 1-5) compared to 2 (IQR 0-4) in deceased. A logistic model including RESP score variables poorly discriminated survival and death with AUC (area under curve) 0.61 (95% confidence interval: 0.59-0.64). In-hospital survival for COVID-19 patients based on RESP score class from I to V was 69.7%, 59.3%, 45.7%, 42.5%, and 32.3%, respectively. Patients with immunosuppression (relative risk = 0.43) and pre-ECMO cardiac arrest (relative risk = 0.48) had lower survival. RESP score is a poor predictor of survival in COVID-19 patients undergoing ECMO. Compared to the original cohort used for RESP score creation, COVID-19 patients in RESP class I-III had worse survival whereas the patients in RESP class IV-V had better survival.