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The criteria for the selection of COVID-19 patients that could benefit most from ECMO organ support are yet to be defined. In this study, we evaluated the predictive performance of ECMO mortality predictive models in patients with COVID-19. We also performed a cost-benefit analysis depending on the mortality predicted probability. We conducted a retrospective cohort study in COVID-19 patients who received ECMO at two tertiary care hospitals between March 2020 to July 2021. We evaluated the discrimination (C-statistic), calibration (Cox calibration), and accuracy of the prediction of death due to severe ARDS in V-V ECMO score (PRESERVE), the Respiratory Extracorporeal Membrane Oxygenation Survival Score (RESP) score, and the PREdiction of Survival on ECMO Therapy-Score (PRESET) score. In addition, we compared the RESP score with Plateau pressure instead of Peak pressure. We included a total of 36 patients, 29 (80%) of them male and with a median (IQR) APACHE of 10 (8-15). The PRESET score had the highest discrimination (AUROCs 0.81 [95%CI 0.67 - 0.94]) and calibration (calibration-in-the-large 0.5 [95%CI -1.4 - 0.3]; calibration slope 2.2 [95%CI 0.7 / 3.7]). The RESP score with Plateau pressure had higher discrimination than the conventional RESP score. The cost per QALY in the USA, adjusted to life expectancy, was higher than USD 100,000 in patients older than 45 years with a PRESET10. The PRESET score had the highest predictive performance and could help in the selection of patients that benefit most from this resource-demanding and highly invasive organ support.

Frailty status is a condition which is not merely induced by aging but mainly by a progressive and sustained deterioration of several body physiological processes that lead to an increased vulnerability to stressors. The prevalence of frailty is higher in older individuals with chronic kidney disease (CKD) compared to older people with normal renal function. Frailty prevalence increases with a worsened kidney function, which leads to an increase in falls, hospitalization, dialysis requirement, and mortality. CKD predisposes to frailty through many mechanisms, which can also lead to CKD progression. The coexistence of CKD and frailty phenotype has been considered a particular condition known as “senescent nephropathy,” since it is characterized by significant clinical complications, therapeutic demands, and worse prognosis, in comparison with robust older CKD patients. Frailty status trends should be identified since they represent an opportunity to successfully intervene by optimizing nutritional and rehabilitation efforts. The prevention or delay of the appearance of frailty and sarcopenia can be accomplished by low intensity resistance and aerobic physical exercise, caloric and protein intake, vitamin D supplementation, and avoidance of polypharmacy. In addition, these patients should also receive their corresponding CKD treatment, but even frailty evaluation can contribute to redesign the patient’s therapeutic objectives.