PREdiction of Survival on ECMO Therapy (PRESET) Score

PRESET Score Calculator

Age ≥65 years

Immunocompromised

SOFA score ≥12

Mechanical ventilation > 7 days before ECMO

Cardiac arrest pre-ECMO

pH < 7.2

Lactate > 5 mmol/L

Platelets < 100 ×10³/µL

PRESET Score: 0

Best Prognosis

PRESET Score: 0. No negative prognostic factors identified. Best expected survival on ECMO.

Predicts survival after ECMO for acute respiratory distress syndrome.

Why Use

Offers a structured, evidence-based approach to estimating mortality risk in ECMO candidates and helps guide discussions on prognosis. Facilitates more standardized triage decisions and resource allocation. Unlike many similar ECMO risk scores, this tool relies exclusively on extrapulmonary variables in its risk assessment.

When to Use

Consider using in critically ill patients with acute respiratory distress syndrome (ARDS) who are candidates for veno-venous ECMO to help assess their likelihood of survival on ECMO.

Formula

The PRESET Score is calculated by the addition of the selected points: Variable Points Mean arterial pressure, mmHg >100 0 91-100 1 81-90 2 71-80 3 ≤70 4 Lactate concentration, mmol/L ≤1.50 0 1.51-3.00 1 3.01-6.00 2 6.01-10.00 3 >10.00 4 pH a >7.300 0 7.201-7.300 1 7.101-7.200 2 ≤7.100 3 Platelet concentration, x 1000 cells/μl >200 0 101-200 1 ≤100 2 Hospital days pre-ECMO ≤2 0 3-7 1 >7 2

Pearls / Pitfalls

Derived from data on 108 adult patients with ARDS on veno-venous ECMO (all using an identical ECMO system) at a single center; application to other patient groups or different ECMO systems may affect accuracy. In the derivation study, this tool outperformed several similar scores (e.g., ECMOnet, RESP Score , PRESERVE Score, Roch Score) in predicting mortality. Interestingly, respiratory variables were not found to predict survival in the development of this score. This tool provides an estimate of in-hospital survival and does not address long-term survival, quality of life, or disability.

Advice

Use the results of this tool in conjunction with other clinical parameters and specialist expertise—no single score should be the sole determinant for ECMO candidacy. Incorporate results into ECMO therapy planning if the patient is otherwise a suitable candidate, and engage in goals-of-care conversations that include therapy limitations, alternative salvage interventions, and palliative care options.

More Information

Interpretation: PRESET Score Risk Class ICU Mortality 0-5 Class I 26% 6-9 Class II 68% 10-15 Class III 93% From Hilder 2017 .