RESP Score
Respiratory ECMO Survival Prediction
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Valores previos al inicio de ECMO
Trastorno del SNC
Infección asociada (no pulmonar)
Uso de bloqueantes neuromusculares
Uso de óxido nítrico
Adm. de bicarbonato
PCR previa
PaCO2 ≥75 mmHg
P.Pico inspiratoria ≥42c mH2O
RESP score

1.Predicting survival after ECMO for severe acute respiratory failure: the Respiratory ECMO Survival Prediction (RESP) Score. Available from:

La supervivencia hospitalaria acumulada predicha fue de 92, 76, 57, 33 y 18% para cinco clases de riesgo de RESP scores ;I (≥ 6), II (3-5), III (-1 a 2), IV (-5 a -2) y V (≤-6 ), respectivamente.
La supervivencia general observada fue mucho menor en las clases de riesgo V y VI (es decir, puntaje RESP ≤-2) que en las clases de riesgo III, II e I (es decir, puntaje RESP ≥ -1) (15.5 vs. 91.5%, respectivamente). La validación externa del puntaje deRESP en la muestra de datos PRESERVE demostró un rendimiento excelente (c = 0,92 [IC 95%, 0,89-0,97]) en contraste con una discriminación más pobre del SAPS II (c = 0,60 [IC 95%, 0,51-0,70]) y puntuación SOFA (c = 0.58 [IC 95%, 0.48-0.67]) en los datos PRESERVE.
LIMITACIONES Our study’s strengths are the large international population studied, the detailed pre-ECMO parameters on patients with acute severe respiratory failure, and a predictive survival model on ECMO validated internally and externally on various acute respiratory failure diagnosis groups. However, there are some limitations. First, the study lasts for a 13-year period with an improvement of overall survival between 2000 and 2008, and 2009 and 2012 (see Figure E2). During the past decade, new generations of ECMO devices have been developed (8) and a landmark randomized trial has been published (5). Therefore, we cannot exclude that global management of ECMO for severe acute respiratory failure may have changed during the study’s period and may also change before the potential application of the RESP score into clinical practice. It is possible that the RESP score in commonwith other scoring systems will lose calibration over time and may need further adaptation in future (34). However, because nearly two-thirds (1,464 of 2,355) of the patients used to construct the score were from the most recent 4 years (2009–2012), it is likely the RESP score reflects contemporary clinical practices. Second, although reporting one of the largest populations of ECMO with adult acute respiratory failure published to date, it is worth noting that prone positioning use is not reported in the pre-ECMO therapy section of the ELSO registry. According to the recent positive effect of prone positioning in both the PROSEVA trial (31) and the PRESERVE score (9), this omission could have affected our results. Third, lung infection without further details was reported by 28% of the population. The possible inclusion of patients with bacterial or viral pneumonia in this “other acute respiratory diagnoses” group may affect external application of the RESP score. Fourth, excluding blood gases, no preECMO biologic data are currently available in the ELSO registry. Modern well-calibrated and highly discriminatory risk prediction models for critically ill patients are derived from large datasets, which include extensive physiologic and biochemical information to enhance severity of illness assessment (35). The SOFA score or its biologic components have been associated with outcome in three recent studies aimed at developing mortality risk models in ECMO (9, 15, 16). More detailed biologic and chronic health data may have enhanced the accuracy of our model (15). Fifth, all items of the RESP score were not recorded in the external validation dataset (i.e., neuromuscular blocker use, plateau pressure instead of peak pressure). Finally, it is worth remembering that the RESP score has been developed on patients already on ECMO. It has not been validated for prediction of survival in a more general population of patients with severe acute respiratory failure where ECMO has not (yet) been instituted. In conclusion, the overall hospital survival of 2,355 patients with severe acute respiratory failure extracted from an international cohort over a 13-year period was 57%. The RESP score offers, through 12 simple pre-ECMO items, a relevant and validated tool to predict survival for patients receiving ECMO for respiratory failure. Further international prospective studies aiming to evaluate the performance of the RESP score are now warranted. n