Intensive Care Medicine

, Volume 39, Issue 2, pp 275–281

Predicting mortality risk in patients undergoing venovenous ECMO for ARDS due to influenza A (H1N1) pneumonia: the ECMOnet score

  • Federico Pappalardo
  • Marina Pieri
  • Teresa Greco
  • Nicolò Patroniti
  • Antonio Pesenti
  • Antonio Arcadipane
  • V. Marco Ranieri
  • Luciano Gattinoni
  • Giovanni Landoni
  • Bernhard Holzgraefe
  • Gernot Beutel
  • Alberto Zangrillo
  • on behalf of the Italian ECMOnet
Original

DOI: 10.1007/s00134-012-2747-1

Cite this article as:
Pappalardo, F., Pieri, M., Greco, T. et al. Intensive Care Med (2013) 39: 275. doi:10.1007/s00134-012-2747-1

Abstract

Purpose

The decision to start venovenous extracorporeal membrane oxygenation (VV ECMO) is commonly based on the severity of respiratory failure, with little consideration of the extrapulmonary organ function. The aim of the study was to identify predictors of mortality and to develop a score allowing a better stratification of patients at the time of VV ECMO initiation.

Methods

This was a prospective multicenter cohort study on 60 patients with influenza A (H1N1)-associated respiratory distress syndrome participating in the Italian ECMOnet data set in the 2009 pandemic. Criteria for ECMO institution were standardized according to national guidelines.

Results

The survival rate in patients treated with ECMO was 68 %. Significant predictors of death before ECMO institution by multivariate analysis were hospital length of stay before ECMO institution (OR = 1.52, 95 % CI 1.12–2.07, p = 0.008); bilirubin (OR = 2.32, 95 % CI 1.52–3.52, p < 0.001), creatinine (OR = 7.38, 95 % CI 1.43–38.11, p = 0.02) and hematocrit values (OR = 0.82, 95 % CI 0.72–0.94, p = 0.006); and mean arterial pressure (OR = 0.92, 95 % CI 0.88–0.97, p < 0.001). The ECMOnet score was developed based on these variables, with a score of 4.5 being the most appropriate cutoff for mortality risk prediction. The high accuracy of the ECMOnet score was further confirmed by ROC analysis (c = 0.857, 95 % CI 0.754–0.959, p < 0.001) and by an independent external validation analysis (c = 0.694, 95 % CI 0.562–0.826, p = 0.004).

Conclusions

Mortality risk for patients receiving VV ECMO is correlated to the extrapulmonary organ function at the time of ECMO initiation. The ECMOnet score is a tool for the evaluation of the appropriateness and timing of VV ECMO in acute lung failure.

Keywords

Acute respiratory distress syndrome ECMO Extracorporeal membrane oxygenation H1N1 virus Mortality Multiple organ failure 

Supplementary material

134_2012_2747_MOESM1_ESM.doc (81 kb)
Supplementary material 1 (DOC 81 kb)

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2012

Authors and Affiliations

  • Federico Pappalardo
    • 1
  • Marina Pieri
    • 1
  • Teresa Greco
    • 1
  • Nicolò Patroniti
    • 2
  • Antonio Pesenti
    • 2
  • Antonio Arcadipane
    • 3
  • V. Marco Ranieri
    • 4
  • Luciano Gattinoni
    • 5
  • Giovanni Landoni
    • 1
  • Bernhard Holzgraefe
    • 6
  • Gernot Beutel
    • 7
  • Alberto Zangrillo
    • 1
  • on behalf of the Italian ECMOnet
  1. 1.Department of Cardiac Anesthesia and Intensive CareVita-Salute San Raffaele UniversityMilanItaly
  2. 2.Department of Experimental MedicineUniversity of Milano Bicocca, San Gerardo HospitalMonzaItaly
  3. 3.Department of Anesthesia and Critical CareMediterranean Institute for Transplantation and Advanced Specialized TherapiesPalermoItaly
  4. 4.Department of Anesthesia and Critical Care MedicineUniversity of Turin, S. Giovanni Battista-Molinette HospitalTurinItaly
  5. 5.Department of AnesthesiaIRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, University of MilanMilanItaly
  6. 6.Department of Physiology and Pharmacology, ECMO Department Karolinska Astrid Lindgren Children′s HospitalKarolinska Institutet, Karolinska University HospitalSolnaSweden
  7. 7.Department of Hematology, Hemostasis, Oncology, and Stem Cell TransplantationHannover Medical School (MHH)HannoverGermany

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