respiratory anaesthesia-icu

RESP Score for Respiratory ECMO Survival Prediction

Respiratory ECMO Survival Prediction (RESP) score. Predicts in-hospital survival for patients receiving veno-venous ECMO (VV-ECMO) for acute respiratory failure. Based on 12 pre-ECMO variables. Score -22 to +15; Class I (score above 5) = 92% survival; Class V (score below -5) = 18% survival. Developed by Schmidt et al. 2014 from the ELSO registry of 2,355 patients. Used to guide ECMO candidacy decisions.

Age*

Immunocompromised (HIV, post-transplant, chronic immunosuppression, haematological malignancy)*

Mechanical ventilation duration before ECMO*

Primary diagnosis (indication for ECMO)*

CNS dysfunction (hemiparesis/paralysis, CVA, structural intracranial disease, encephalopathy, or seizures)*

Acute associated (non-pulmonary) infection*

Neuromuscular blocking agents before ECMO*

Inhaled nitric oxide before ECMO*

Bicarbonate infusion before ECMO*

Cardiac arrest before ECMO*

PaCO₂ ≥ 75 mmHg (10 kPa)*

Peak inspiratory pressure ≥ 42 cmH₂O*

Score interpretation

RESP Class I — Predicted Survival 92% 6–15

RESP ≥ 6: risk class I; predicted in-hospital survival 92% (Schmidt 2014).

→ Strong indication for VV-ECMO; discuss with ECMO centre immediately; initiate transfer if not at ECMO-capable centre; ensure all conventional therapy maximised first (prone positioning, recruitment manoeuvres, neuromuscular blockade, inhaled NO if available); ECMO consent; ideally VV-ECMO initiated by experienced team (ECMO-competent centre per ELSO guidelines); post-ECMO: continue lung-protective ventilation (very low TV 1-3 mL/kg, low frequency); target lung rest; monitor circuit (oxygenator, pump, pressures); document RESP score in ECMO referral.

RESP Class II — Predicted Survival 76% 3–5

RESP 3 to 5: risk class II; predicted in-hospital survival 76%.

→ ECMO indicated; refer to ECMO centre; while awaiting or transferring: maximise conventional ARDS management (prone 16+ hours/day, cisatracurium for severe ARDS, inhaled NO); ECMO centre case discussion; document clinical trajectory and treatment escalation; family meeting regarding ECMO benefits and risks.

RESP Class III — Predicted Survival 57% -1–2

RESP −1 to 2: risk class III; predicted in-hospital survival 57%.

→ ECMO may be beneficial; MDT discussion at ECMO centre; consider all conventional rescue therapies (prone, inhaled NO, HFOV as rescue); balance ECMO benefit against patient comorbidities; frank goals of care discussion with family; if ECMO pursued: ECMO centre expertise critical at this risk level; document discussion.

RESP Class IV — Predicted Survival 33% -5–-2

RESP −5 to −2: risk class IV; predicted in-hospital survival 33%.

→ ECMO is high risk; MDT discussion required (intensivists, ECMO team, family); consider whether ECMO is appropriate given poor predicted outcomes; patient and family goals of care discussion -- ECMO as bridge to recovery vs futility; some patients in Class IV-V may still be considered if reversible cause (e.g., severe asthma, young patient); palliative care involvement; if ECMO declined or considered futile: compassionate extubation with palliative symptom control; document decision clearly in notes including risks and goals of care.

RESP Class V — Predicted Survival 18% -22–-6

RESP ≤ −6: risk class V; predicted in-hospital survival 18%.

Interpretation bands for the RESP Score. Apply clinical judgement and local guidance.

References

Schmidt M 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):1374-1382.

Curated clinical cross-links plus same-class fallbacks.

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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