RESP (Respiratory ECMO Survival Prediction) Score online calculator

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

RESP Score should be used in patients receiving venovenous (VV) and veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) for acute respiratory failure. NB! Do not use in patients receiving VA ECMO for cardiogenic shock (see SAVE Score).

Age, years
18-49
50-59
≥60

Immunocompromised status at time of ECMO
Any malignancy, solid organ transplant, HIV, or cirrhosis:

Yes
No

Mechanically ventilated before ECMO initiated:
48 hours to 7 days
<48 hours

Diagnosis:
Viral pneumonia
Bacterial pneumonia
Asthma
Trauma or burn
Aspiration pneumonitis
Other acute respiratory diagnosis
Nonrespiratory or chronic respiratory diagnosis

History of central nervous system dysfunction
Neurotrauma, stroke, encephalopathy, cerebral embolism, or seizure/epilepsy:

Yes
No

Acute associated nonpulmonary infection
Any other bacterial, viral, parasitic, or fungal infection not involving the lung:

Yes
No

Neuromuscular blockade before ECMO:
Yes
No

Nitric oxide before ECMO:
Yes
No

Bicarbonate infusion before ECMO:
Yes
No

Cardiac arrest before ECMO:
Yes
No

PaCO₂ ≥75 mmHg (≥10 kPa):
Yes
No

Peak inspiratory pressure ≥42 cm H₂O (≥4.1 kPa):
Yes
No




Patient’s score RESP Score Risk class In-hospital survival
0 0 0 0

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

Addition of the selected points:

Age, years18-490
 50-59-2
 ≥60-3
Immunocompromised status at time of ECMO
Any malignancy, solid organ transplant, HIV, or cirrhosis
No0
 Yes-2
Mechanically ventilated before ECMO initiated>7 days0
 48 hours to 7 days+1
 <48 hours+3
DiagnosisViral pneumonia+3
 Bacterial pneumonia+3
 Asthma+11
 Trauma or burn+3
 Aspiration pneumonitis+5
 Another acute respiratory diagnosis+1
 Nonrespiratory or chronic respiratory diagnosis0
History of central nervous system dysfunction
Neurotrauma, stroke, encephalopathy, cerebral embolism, or seizure/epilepsy
No0
 Yes-7
Acute associated nonpulmonary infection
Any other bacterial, viral, parasitic, or fungal infection not involving the lung
No0
 Yes-3
Neuromuscular blockade before ECMONo0
 Yes+1
Nitric oxide before ECMONo0
 Yes-1
Bicarbonate infusion before ECMONo0
 Yes-2
Cardiac arrest before ECMONo0
 Yes-2
PaCO 75 mmHg (10 kPa)No0
 Yes-1
Peak inspiratory pressure ≥42 cm HO (4.1 kPa)No0
 Yes-1

Interpretation:

RESP ScoreRisk classIn-hospital survival
≥6I92%
3-5II76%
-1 to 2III57%
-5 to -2IV33%
≤-6V18%

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

The RESP Score only predicts survival before hospital discharge and does not predict neurologic function or functional status, that 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.

RESP Score Assessment can be useful in survival prediction and may be incorporated into the decision to initiate VA ECMO.

Prone positioning was not included in the derivation of the RESP Score, and its effect on the predictive value of the score is unknown.

The RESP Score was derived in a retrospective cohort study by Schmidt et al (2014), which included 2,355 patients in the Extracorporeal Life Support Organization (ELSO) registry who received ECMO for acute respiratory failure. Patients receiving ECMO for indications other than acute respiratory failure (e.g. cardiogenic shock) were excluded. Predictive variables with p-values ≤0.05 were included to derive the final score.

The score was prospectively validated in 140 patients (included in initial publication) (c = 0.92, CI 0.89-0.97). In a small retrospective study of 41 patients (Brunet 2017), the score was found to have low predictive value for mortality (c-index 0.60).

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

Predicts chances of mortality after on ECMO in COVID-19 patients, performing better in validations than PRESET Score.

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Literature:
1. Schmidt M, Bailey M, Sheldrake J, et al. 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;189(11):1374-82. https://pubmed.ncbi.nlm.nih.gov/24693864/
2. Brunet J, Valette X, Buklas D, et al. Predicting Survival After Extracorporeal Membrane Oxygenation for ARDS: An External Validation of RESP and PRESERVE Scores. Respir Care. 2017;62(7):912-919. https://pubmed.ncbi.nlm.nih.gov/28536282/

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