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01-10-2013 | Seven-Day Profile Publication

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

Authors: 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

Published in: Intensive Care Medicine | Issue 10/2013

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.

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Sud S, Friedrich JO, Taccone P, Polli F, Adhikari NK, Latini R, Pesenti A, Guerin C, Mancebo J, Curley MA, Fernandez R, Chan MC, Beuret P, Voggenreiter G, Sud M, Tognoni G, Gattinoni L (2010) Prone ventilation reduces mortality in patients with acute respiratory failure and severe hypoxemia: systematic review and meta-analysis. Intensive Care Med 36:585–599PubMedCrossRef

Adhikari NK, McAndrews MP, Tansey CM, Matte A, Pinto R, Cheung AM, Diaz-Granados N, Barr A, Herridge MS (2009) Self-reported symptoms of depression and memory dysfunction in survivors of ARDS. Chest 135:678–687PubMedCrossRef

Davidson TA, Caldwell ES, Curtis JR, Hudson LD, Steinberg KP (1999) Reduced quality of life in survivors of acute respiratory distress syndrome compared with critically ill control patients. JAMA 281:354–360PubMedCrossRef

Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F, Cooper AB, Guest CB, Mazer CD, Mehta S, Stewart TE, Barr A, Cook D, Slutsky AS (2003) One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med 348:683–693PubMedCrossRef

Herridge MS, Tansey CM, Matte A, Tomlinson G, Diaz-Granados N, Cooper A, Guest CB, Mazer CD, Mehta S, Stewart TE, Kudlow P, Cook D, Slutsky AS, Cheung AM (2011) Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 364:1293–1304PubMedCrossRef

Heyland DK, Groll D, Caeser M (2005) Survivors of acute respiratory distress syndrome: relationship between pulmonary dysfunction and long-term health-related quality of life. Crit Care Med 33:1549–1556PubMedCrossRef

Combes A, Bacchetta M, Brodie D, Muller T, Pellegrino V (2012) Extracorporeal membrane oxygenation for respiratory failure in adults. Curr Opin Crit Care 18:99–104PubMedCrossRef

MacLaren G, Combes A, Bartlett RH (2012) Contemporary extracorporeal membrane oxygenation for adult respiratory failure: life support in the new era. Intensive Care Med 38:210–220PubMedCrossRef

Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, Hibbert CL, Truesdale A, Clemens F, Cooper N, Firmin RK, Elbourne D (2009) Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 374:1351–1363PubMedCrossRef

10.

Brodie D, Bacchetta M (2012) Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med 365:1905–1914CrossRef

11.

Combes A, Brechot N, Luyt CE, Schmidt M (2012) What is the niche for extracorporeal membrane oxygenation in severe acute respiratory distress syndrome? Curr Opin Crit Care 18:527–532PubMedCrossRef

12.

Pham T, Combes A, Roze H, Chevret S, Mercat A, Roch A, Mourvillier B, Ara-Somohano C, Bastien O, Zogheib E, Clavel M, Constan A, Marie Richard JC, Brun-Buisson C, Brochard L (2013) Extracorporeal membrane oxygenation for pandemic influenza A(H1N1)-induced acute respiratory distress syndrome: a Cohort study and propensity-matched analysis. Am J Respir Crit Care Med 187:276–285PubMedCrossRef

13.

Noah MA, Peek GJ, Finney SJ, Griffiths MJ, Harrison DA, Grieve R, Sadique MZ, Sekhon JS, McAuley DF, Firmin RK, Harvey C, Cordingley JJ, Price S, Vuylsteke A, Jenkins DP, Noble DW, Bloomfield R, Walsh TS, Perkins GD, Menon D, Taylor BL, Rowan KM (2011) Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). JAMA 306:1659–1668PubMedCrossRef

14.

Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell N, Forrest P, Gattas D, Granger E, Herkes R, Jackson A, McGuinness S, Nair P, Pellegrino V, Pettila V, Plunkett B, Pye R, Torzillo P, Webb S, Wilson M, Ziegenfuss M (2009) Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA 302:1888–1895PubMedCrossRef

15.

Hemmila MR, Rowe SA, Boules TN, Miskulin J, McGillicuddy JW, Schuerer DJ, Haft JW, Swaniker F, Arbabi S, Hirschl RB, Bartlett RH (2004) Extracorporeal life support for severe acute respiratory distress syndrome in adults. Ann Surg 240:595–605 discussion 605–597PubMed

16.

Brogan TV, Thiagarajan RR, Rycus PT, Bartlett RH, Bratton SL (2009) Extracorporeal membrane oxygenation in adults with severe respiratory failure: a multi-center database. Intensive Care Med 35:2105–2114PubMedCrossRef

17.

Guerin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, Mercier E, Badet M, Mercat A, Baudin O, Clavel M, Chatellier D, Jaber S, Rosselli S, Mancebo J, Sirodot M, Hilbert G, Bengler C, Richecoeur J, Gainnier M, Bayle F, Bourdin G, Leray V, Girard R, Baboi L, Ayzac L (2013) Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 368:2159–2168PubMedCrossRef

18.

(2000) Acute respiratory distress syndrome network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308

19.

Hodgson CL, Hayes K, Everard T, Nichol A, Davies AR, Bailey MJ, Tuxen DV, Cooper DJ, Pellegrino V (2012) Long-term quality of life in patients with acute respiratory distress syndrome requiring extracorporeal membrane oxygenation for refractory hypoxaemia. Crit Care 16:R202PubMedCrossRef

20.

Linden VB, Lidegran MK, Frisen G, Dahlgren P, Frenckner BP, Larsen F (2009) ECMO in ARDS: a long-term follow-up study regarding pulmonary morphology and function and health-related quality of life. Acta Anaesthesiol Scand 53:489–495PubMedCrossRef

21.

Luyt CE, Combes A, Becquemin MH, Beigelman-Aubry C, Hatem S, Brun AL, Zraik N, Carrat F, Grenier PA, Richard JC, Mercat A, Brochard L, Brun-Buisson C, Chastre J (2012) Long-term outcomes of pandemic 2009 influenza A(H1N1)-associated severe ARDS. Chest 142:583–592PubMedCrossRef

22.

EOLIA trial, Accessed May 15th, 2013. http://wwwclinicaltrialsgov/ct2/show/NCT01470703?term=eolia&rank=1

23.

Schmidt M, Tachon G, Devilliers C, Muller G, Hekimian G, Brechot N, Merceron S, Luyt CE, Trouillet JL, Chastre J, Leprince P, Combes A (2013) Blood oxygenation and decarboxylation determinants during venovenous ECMO for respiratory failure in adults. Intensive Care Med 39:838–846PubMedCrossRef

24.

Schmidt M, Brechot N, Hariri S, Guiguet M, Luyt CE, Makri R, Leprince P, Trouillet JL, Pavie A, Chastre J, Combes A (2012) Nosocomial infections in adult cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation. Clin Infect Dis 55:1633–1641PubMedCrossRef

25.

Mirabel M, Luyt CE, Leprince P, Trouillet JL, Leger P, Pavie A, Chastre J, Combes A (2011) Outcomes, long-term quality of life, and psychologic assessment of fulminant myocarditis patients rescued by mechanical circulatory support. Crit Care Med 39:1029–1035PubMedCrossRef

26.

Trouillet JL, Luyt CE, Guiguet M, Ouattara A, Vaissier E, Makri R, Nieszkowska A, Leprince P, Pavie A, Chastre J, Combes A (2011) Early percutaneous tracheotomy versus prolonged intubation of mechanically ventilated patients after cardiac surgery: a randomized trial. Ann Intern Med 154:373–383PubMedCrossRef

27.

Leplege A, Ecosse E, Verdier A, Perneger TV (1998) The French SF-36 Health Survey: translation, cultural adaptation and preliminary psychometric evaluation. J Clin Epidemiol 51:1013–1023PubMedCrossRef

28.

Jones PW, Quirk FH, Baveystock CM (1991) The St George’s Respiratory Questionnaire. Respiratory medicine 85(Suppl B):25–31 discussion 33–27PubMedCrossRef

29.

Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370PubMedCrossRef

30.

Horowitz M, Wilner N, Alvarez W (1979) Impact of Event Scale: a measure of subjective stress. Psychosom Med 41:209–218PubMed

31.

Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. JAMA 185:914–919PubMedCrossRef

32.

Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186PubMedCrossRef

33.

Dowdy DW, Eid MP, Dennison CR, Mendez-Tellez PA, Herridge MS, Guallar E, Pronovost PJ, Needham DM (2006) Quality of life after acute respiratory distress syndrome: a meta-analysis. Intensive Care Med 32:1115–1124PubMedCrossRef

34.

Tansey CM, Louie M, Loeb M, Gold WL, Muller MP, de Jager J, Cameron JI, Tomlinson G, Mazzulli T, Walmsley SL, Rachlis AR, Mederski BD, Silverman M, Shainhouse Z, Ephtimios IE, Avendano M, Downey J, Styra R, Yamamura D, Gerson M, Stanbrook MB, Marras TK, Phillips EJ, Zamel N, Richardson SE, Slutsky AS, Herridge MS (2007) One-year outcomes and health care utilization in survivors of severe acute respiratory syndrome. Arch Intern Med 167:1312–1320PubMedCrossRef

35.

Bienvenu OJ, Colantuoni E, Mendez-Tellez PA, Dinglas VD, Shanholtz C, Husain N, Dennison CR, Herridge MS, Pronovost PJ, Needham DM (2012) Depressive symptoms and impaired physical function after acute lung injury: a 2-year longitudinal study. Am J Respir Crit Care Med 185:517–524PubMedCrossRef

36.

Ringdal M, Plos K, Ortenwall P, Bergbom I (2010) Memories and health-related quality of life after intensive care: a follow-up study. Crit Care Med 38:38–44PubMedCrossRef

37.

Myhren H, Ekeberg O, Stokland O (2010) Health-related quality of life and return to work after critical illness in general intensive care unit patients: a 1-year follow-up study. Crit Care Med 38:1554–1561PubMedCrossRef

38.

Schelling G, Stoll C, Haller M, Briegel J, Manert W, Hummel T, Lenhart A, Heyduck M, Polasek J, Meier M, Preuss U, Bullinger M, Schuffel W, Peter K (1998) Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Crit Care Med 26:651–659PubMedCrossRef

39.

Combes A, Costa MA, Trouillet JL, Baudot J, Mokhtari M, Gibert C, Chastre J (2003) Morbidity, mortality, and quality-of-life outcomes of patients requiring > or = 14 days of mechanical ventilation. Crit Care Med 31:1373–1381PubMedCrossRef

40.

Drakos SG, Charitos CE, Ntalianis A, Terrovitis JV, Siafakas KX, Dolou P, Pierrakos C, Charitos E, Karelas J, Nanas JN (2005) Comparison of pulsatile with nonpulsatile mechanical support in a porcine model of profound cardiogenic shock. ASAIO J 51:26–29PubMedCrossRef

41.

Brechot N, Luyt CE, Schmidt M, Leprince P, Trouillet JL, Leger P, Pavie A, Chastre J, Combes A (2013) Venoarterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock. Crit Care Med 41:1616–1626PubMedCrossRef

42.

Young D, Lamb SE, Shah S, MacKenzie I, Tunnicliffe W, Lall R, Rowan K, Cuthbertson BH (2013) High-frequency oscillation for acute respiratory distress syndrome. N Engl J Med 368:806–813PubMedCrossRef

43.

Muller T, Philipp A, Luchner A, Karagiannidis C, Bein T, Hilker M, Rupprecht L, Langgartner J, Zimmermann M, Arlt M, Wenger J, Schmid C, Riegger GA, Pfeifer M, Lubnow M (2009) A new miniaturized system for extracorporeal membrane oxygenation in adult respiratory failure. Crit Care 13:R205PubMedCrossRef

44.

Beiderlinden M, Eikermann M, Boes T, Breitfeld C, Peters J (2006) Treatment of severe acute respiratory distress syndrome: role of extracorporeal gas exchange. Intensive Care Med 32:1627–1631PubMedCrossRef

45.

Patroniti N, Zangrillo A, Pappalardo F, Peris A, Cianchi G, Braschi A, Iotti GA, Arcadipane A, Panarello G, Ranieri VM, Terragni P, Antonelli M, Gattinoni L, Oleari F, Pesenti A (2011) The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic: preparation for severe respiratory emergency outbreaks. Intensive Care Med 37:1447–1457PubMedCrossRef

46.

Abhyankar S, Leishear K, Callaghan FM, Demner-Fushman D, McDonald CJ (2012) Lower short- and long-term mortality associated with overweight and obesity in a large cohort study of adult intensive care unit patients. Crit Care 16:R235PubMedCrossRef

47.

Wilcox ME, Herridge MS (2011) Lung function and quality of life in survivors of the acute respiratory distress syndrome (ARDS). Presse Med 40:e595–e603PubMedCrossRef

48.

Eddleston JM, White P, Guthrie E (2000) Survival, morbidity, and quality of life after discharge from intensive care. Crit Care Med 28:2293–2299PubMedCrossRef

49.

Jones C, Griffiths RD, Humphris G, Skirrow PM (2001) Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med 29:573–580PubMedCrossRef

50.

Papazian L, Forel JM, Gacouin A, Penot-Ragon C, Perrin G, Loundou A, Jaber S, Arnal JM, Perez D, Seghboyan JM, Constantin JM, Courant P, Lefrant JY, Guerin C, Prat G, Morange S, Roch A (2010) Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med 363:1107–1116PubMedCrossRef

Title: The PRESERVE mortality risk score and analysis of long-term outcomes after extracorporeal membrane oxygenation for severe acute respiratory distress syndrome
Authors: 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
Publication date: 01-10-2013
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 10/2013
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-013-3037-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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