Barbaro RP, et al. - Researchers assessed predictive accuracy for mortality risk in children receiving extracorporeal membrane oxygenation (ECMO) support for respiratory failure using three commonly used pediatric intensive care unit (PICU) severity of illness scores: pediatric risk of mortality score (PRISM) III, pediatric index of mortality (PIM) 2, and pediatric logistic organ dysfunction (PELOD). In addition, they determined the ability of the Pediatric Risk Estimate Score for Children Using Extracorporeal Respiratory Support (Ped-RESCUERS) to discriminate mortality risk in the same population, and if additional clinical and laboratory measures of renal, hepatic, neurologic, and hematologic dysfunction improves Ped-RESCUERS’ discrimination of mortality. Outcomes do not support using admission PRISM-III, PIM-2, and PELOD for pre-ECMO risk adjustment as they do not discriminate death. To risk adjust ECMO populations, they recommend using extracorporeal membrane oxygenation population-derived scores as opposed to general PICU population-derived scores.