RESP (Respiratory ECMO Survival Prediction) Score

RESP Score Calculator

Age

Immunocompromised Status

Mechanical Ventilation Before ECMO

Acute Respiratory Diagnosis Group

CNS Dysfunction

Acute Non-Pulmonary Organ Failure

Nitric Oxide Use Pre-ECMO

Bicarbonate Infusion Pre-ECMO

Cardiac Arrest Pre-ECMO

PaCO2 ≥ 75 mmHg

Peak Inspiratory Pressure ≥ 42 cmH2O

Total RESP Score: –

Score: 0

Select all criteria. Default scoring assumes 0 for un-set fields.

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

Why Use

ECMO is a resource-intensive endeavor with high morbidity, and patients should be selected carefully. Survival estimates may aid the decision process.

When to Use

Patients receiving veno-venous (VV) and veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) for acute respiratory failure. Do not use in patients receiving VA ECMO for cardiogenic shock (see SAVE Score ).

Formula

Addition of the selected points: Variable Points Age, years 18-49 0 50-59 -2 ≥60 -3 Immunocompromised status at time of ECMO (any malignancy, solid organ transplant, HIV, or cirrhosis) No 0 Yes -2 Mechanically ventilated before ECMO >7 days 0 48 hours to 7 days 1 <48 hours 3 Diagnosis Viral pneumonia 3 Bacterial pneumonia 3 Asthma 11 Trauma or burn 3 Aspiration pneumonitis 5 Other acute respiratory diagnosis 1 Nonrespiratory or chronic respiratory diagnosis 0 History of central nervous system dysfunction (neurotrauma, stroke, encephalopathy, cerebral embolism, or seizure/epilepsy) No 0 Yes -7 Acute associated nonpulmonary infection (any other bacterial, viral, parasitic, or fungal infection not involving the lung) No 0 Yes -3 Neuromuscular blockade before ECMO No 0 Yes 1 Nitric oxide before ECMO No 0 Yes -1 Bicarbonate infusion before ECMO No 0 Yes -2 Cardiac arrest before ECMO No 0 Yes -2 PaCO₂ ≥75 mmHg (≥10 kPa) No 0 Yes -1 Peak inspiratory pressure ≥42 cm H₂O (≥4.1 kPa) No 0 Yes -1

Pearls / Pitfalls

The RESP Score only predicts survival to hospital discharge and does not predict neurologic function or functional status, which may be important considerations. The score was derived from a cohort of patients who were placed on ECMO, and likely excluded many patients who may have had different survival rates. Prone positioning was not included in the derivation of the RESP Score, and its effect on the predictive value of the score is unknown.

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.

Advice

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

More Information

Interpretation: RESP Score Risk class In-hospital survival ≥6 I 92% 3-5 II 76% -1 to 2 III 57% -5 to -2 IV 33% ≤-6 V 18%