Judith was turned down for ECMO support for two major reasons. First, with her sepsis, she is hyperdynamic with a high cardiac output, and very vasodilated with significant hypotension despite pressors. On VV ECMO she would likely have evne lower saturations than she has now, and although she could have more oxygen carrying capacity with transfusion, it is unlikely VV support with rest settings would improve her overall DO2, and may actually make it worse. She is not a candidate for high flow VA support (sometimes called “central ECMO”) because of her size, vascular access issues, and her desquamation.

More importantly, using the SCORETEN score system to predict mortality with SJS or TEN, she has a 90% mortality, so she was also declined based on lack of reversibility of her underlying condition. The SCORETEN system is summarized below, including Judith’s score at the time of consultation. It can also be found with the references in the Ryan Library. Judith expired the following day.