Intensive Care Medicine

, Volume 39, Issue 10, pp 1704–1713 | Cite as

The PRESERVE mortality risk score and analysis of long-term outcomes after extracorporeal membrane oxygenation for severe acute respiratory distress syndrome

  • Matthieu Schmidt
  • Elie Zogheib
  • Hadrien Rozé
  • Xavier Repesse
  • Guillaume Lebreton
  • Charles-Edouard Luyt
  • Jean-Louis Trouillet
  • Nicolas Bréchot
  • Ania Nieszkowska
  • Hervé Dupont
  • Alexandre Ouattara
  • Pascal Leprince
  • Jean Chastre
  • Alain Combes
Seven-Day Profile Publication

Abstract

Purpose

This study was designed to identify factors associated with death by 6 months post-intensive care unit (ICU) discharge and to develop a practical mortality risk score for extracorporeal membrane oxygenation (ECMO)-treated acute respiratory distress syndrome (ARDS) patients. We also assessed long-term survivors’ health-related quality of life (HRQL), respiratory symptoms, and anxiety, depression and post-traumatic stress disorder (PTSD) frequencies.

Methods

Data from 140 ECMO-treated ARDS patients admitted to three French ICUs (2008–2012) were analyzed. ICU survivors contacted >6 months post-ICU discharge were assessed for HRQL, psychological and PTSD status.

Results

Main ARDS etiologies were bacterial (45 %), influenza A[H1N1] (26 %) and post-operative (17 %) pneumonias. Six months post-ICU discharge, 84 (60 %) patients were still alive. Based on multivariable logistic regression analysis, the PRESERVE (PRedicting dEath for SEvere ARDS on VV-ECMO) score (0–14 points) was constructed with eight pre-ECMO parameters, i.e. age, body mass index, immunocompromised status, prone positioning, days of mechanical ventilation, sepsis-related organ failure assessment, plateau pressure andpositive end-expiratory pressure. Six-month post-ECMO initiation cumulative probabilities of survival were 97, 79, 54 and 16 % for PRESERVE classes 0–2, 3–4, 5–6 and ≥7 (p < 0.001), respectively. HRQL evaluation in 80 % of the 6-month survivors revealed satisfactory mental health but persistent physical and emotional-related difficulties, with anxiety, depression or PTSD symptoms reported, by 34, 25 or 16 %, respectively.

Conclusions

The PRESERVE score might help ICU physicians select appropriate candidates for ECMO among severe ARDS patients. Future studies should also focus on physical and psychosocial rehabilitation that could lead to improved HRQL in this population.

Keywords

Extracorporeal membrane oxygenation Acute respiratory distress syndrome Outcome assessment Long-term quality of life 

Supplementary material

134_2013_3037_MOESM1_ESM.doc (532 kb)
Supplementary material 1 (DOC 532 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • Matthieu Schmidt
    • 1
  • Elie Zogheib
    • 2
  • Hadrien Rozé
    • 3
  • Xavier Repesse
    • 1
  • Guillaume Lebreton
    • 4
  • Charles-Edouard Luyt
    • 1
  • Jean-Louis Trouillet
    • 1
  • Nicolas Bréchot
    • 1
  • Ania Nieszkowska
    • 1
  • Hervé Dupont
    • 2
  • Alexandre Ouattara
    • 3
  • Pascal Leprince
    • 4
  • Jean Chastre
    • 1
  • Alain Combes
    • 1
  1. 1.Medical-Surgical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Service de Réanimation Médicale, Groupe Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de ParisUniversité Pierre et Marie CurieParis CEDEX 13France
  2. 2.Anesthesiology and Critical Care Medicine Department, Amiens University Hospital, INSERM U-1088Université de Picardie Jules VerneAmiens CEDEXFrance
  3. 3.Department of Anesthesia and Critical Care II, CHU de BordeauxUniversité de Bordeaux, Adaptation cardiovasculaire à l’ischémie, U1034Pessac CEDEXFrance
  4. 4.Cardiac Surgery Department, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de ParisUniversité Pierre et Marie CurieParis CEDEX 13France

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