Predictive models in Extracorporeal Membrane Oxygenation (ECMO): a systematic review

Purpose: Extracorporeal Membrane Oxygenation (ECMO) has been increasingly used in the last years to provide hemodynamic and respiratory support in critically ill patients. In this scenario, prognostic scores remain essential to choose which patients should initiate ECMO.This systematic review aims to assess the current landscape and inform subsequent efforts in the development of risk prediction tools for ECMO. Methods: PubMed, CINAHL, Embase, MEDLINE and Scopus were consulted. Articles between Jan 2011 and Feb 2022, including adults undergoing ECMO reporting a developed and validated predictive model, were included. Data extraction aimed to capture study characteristics, risk model characteristics and model performance. The risk of bias was evaluated through the Prediction model Risk Of Bias Assessment Tool (PROBAST). Results: Twenty-six prognostic scores for in-hospital mortality were identified. The most common candidate variables were age, lactate concentration, creatinine concentration, bilirubin concentration, and days in mechanical ventilation prior to ECMO. Five out of 16 venous-arterial (VA)-ECMO scores and 3 out of 9 veno-venous (VV)-ECMO scores had been validated externally. Additionally, one score was developed for both VA and VV populations. No score was judged at low risk of bias. Conclusion: Most models have not been validated externally or are inadequately built and apply after ECMO initiation, failing to answer if ECMO should be initiated or not. It has yet to be determined whether and to what extent a new methodological perspective may enhance the performance of predictive models for ECMO, with the ultimate goal to implement a model that positively influences patient outcomes.