MDCalc

RESP (Respiratory ECMO Survival Prediction) Score

Predicts in-hospital survival in adult patients after ECMO for acute respiratory failure.

Tips for COVID-19: Use to determine ECMO. Predicts chances of mortality after on ECMO, performing better in validations than PRESET Score. Maybe helpful as one of many factors in Crisis Standards of Care decisions. See MDCalc Review: Calcs for Resource Limited Situations.

Age, years

Immunocompromised status at time of ECMO

Any malignancy, solid organ transplant, HIV, or cirrhosis

Mechanically ventilated before ECMO initiated

Diagnosis

History of central nervous system dysfunction

Neurotrauma, stroke, encephalopathy, cerebral embolism, or seizure/epilepsy

Acute associated nonpulmonary infection

Any other bacterial, viral, parasitic, or fungal infection not involving the lung

Neuromuscular blockade before ECMO

Nitric oxide before ECMO

Bicarbonate infusion before ECMO

Cardiac arrest before ECMO

PaCO₂ ≥75 mmHg (≥10 kPa)

Peak inspiratory pressure ≥42 cm H₂O (≥4.1 kPa)

Result:

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Advice

Other factors may contribute to the decision to initiate ECMO (e.g. life expectancy, quality of life, resource availability).

Management

We are not aware of any guidelines that incorporate the score, but survival prediction may be incorporated into the decision to initiate VA ECMO.

Critical Actions

Comprehensive decision-making should not be based solely on one prediction rule, and the threshold to initiate ECMO may vary by institution.  

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