RESP score

Q: A 53-year-old male with viral pneumonia developed severe ARDS post-intubation, requiring deep sedation along with neuromuscular blockade (NMB) without much improvement, and ECMO evaluation was initiated. ECMO team asks to calculate the RESP (Respiratory ECMO Survival Prediction) Score. NMB prior to ECMO insertion is considered a __________ sign for survival. (Select one).

A) good

B) bad

Answer: A

RESP (Respiratory ECMO Survival Prediction) Score looks into the following components prior to ECMO cannulation:

• Age
• Immunocompromised status
• Malignancy, solid organ transplant, HIV, or cirrhosis
• Mechanically ventilated before ECMO initiation
• Diagnosis (if reversible)
• 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)

Most components decrease survival, except short ventilator time, NMB before ECMO, and reversible diagnoses like asthma.

A score calculator is available on any search engine.

#pulmonary

#ECMO

Reference:

Schmidt M, Bailey M, Sheldrake J, Hodgson C, Aubron C, Rycus PT, Scheinkestel C, Cooper DJ, Brodie D, Pellegrino V, Combes A, Pilcher D. Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure. The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score. Am J Respir Crit Care Med. 2014 Jun 1;189(11):1374-82. doi: 10.1164/rccm.201311-2023OC. PMID: 24693864.