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Severe Lung Dysfunction and Pulmonary Blood Flow during Extracorporeal Membrane Oxygenation

Falk, Lars ; Lidegran, Marika ; Diaz Ruiz, Sandra LU ; Hultman, Jan and Broman, Lars Mikael (2024) In Journal of Clinical Medicine 13(4).
Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is indicated for patients with severe respiratory and/or circulatory failure. The standard technique to visualize the extent of pulmonary damage during ECMO is computed tomography (CT). Purpose: This single-center, retrospective study investigated whether pulmonary blood flow (PBF) measured with echocardiography can assist in assessing the extent of pulmonary damage and whether echocardiography and CT findings are associated with patient outcomes. Methods: All patients (>15 years) commenced on ECMO between 2011 and 2017 with septic shock of pulmonary origin and a treatment time >28 days were screened. Of 277 eligible patients, 9 were identified where both CT and... (More)

Background: Extracorporeal membrane oxygenation (ECMO) is indicated for patients with severe respiratory and/or circulatory failure. The standard technique to visualize the extent of pulmonary damage during ECMO is computed tomography (CT). Purpose: This single-center, retrospective study investigated whether pulmonary blood flow (PBF) measured with echocardiography can assist in assessing the extent of pulmonary damage and whether echocardiography and CT findings are associated with patient outcomes. Methods: All patients (>15 years) commenced on ECMO between 2011 and 2017 with septic shock of pulmonary origin and a treatment time >28 days were screened. Of 277 eligible patients, 9 were identified where both CT and echocardiography had been consecutively performed. Results: CT failed to indicate any differences in viable lung parenchyma within or between survivors and non-survivors at any time during ECMO treatment. Upon initiation of ECMO, the survivors (n = 5) and non-survivors (n = 4) had similar PBF. During a full course of ECMO support, survivors showed no change in PBF (3.8 ± 2.1 at ECMO start vs. 7.9 ± 4.3 L/min, p = 0.12), whereas non-survivors significantly deteriorated in PBF from 3.5 ± 1.0 to 1.0 ± 1.1 L/min (p = 0.029). Tidal volumes were significantly lower over time among the non-survivors, p = 0.047. Conclusions: In prolonged ECMO for pulmonary septic shock, CT was not found to be effective for the evaluation of pulmonary viability or recovery. This hypothesis-generating investigation supports echocardiography as a tool to predict pulmonary recovery via the assessment of PBF at the early to later stages of ECMO support.

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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
extracorporeal membrane oxygenation, prognosis, prognostication, prolonged ECMO, pulmonary blood flow, sepsis, septic shock, tidal volume
in
Journal of Clinical Medicine
volume
13
issue
4
article number
1113
publisher
MDPI AG
external identifiers
  • pmid:38398425
  • scopus:85187291357
ISSN
2077-0383
DOI
10.3390/jcm13041113
language
English
LU publication?
yes
id
c853c46c-ee52-4d98-9890-4619024083a3
date added to LUP
2024-04-09 11:47:12
date last changed
2024-04-23 14:37:47
@article{c853c46c-ee52-4d98-9890-4619024083a3,
  abstract     = {{<p>Background: Extracorporeal membrane oxygenation (ECMO) is indicated for patients with severe respiratory and/or circulatory failure. The standard technique to visualize the extent of pulmonary damage during ECMO is computed tomography (CT). Purpose: This single-center, retrospective study investigated whether pulmonary blood flow (PBF) measured with echocardiography can assist in assessing the extent of pulmonary damage and whether echocardiography and CT findings are associated with patient outcomes. Methods: All patients (&gt;15 years) commenced on ECMO between 2011 and 2017 with septic shock of pulmonary origin and a treatment time &gt;28 days were screened. Of 277 eligible patients, 9 were identified where both CT and echocardiography had been consecutively performed. Results: CT failed to indicate any differences in viable lung parenchyma within or between survivors and non-survivors at any time during ECMO treatment. Upon initiation of ECMO, the survivors (n = 5) and non-survivors (n = 4) had similar PBF. During a full course of ECMO support, survivors showed no change in PBF (3.8 ± 2.1 at ECMO start vs. 7.9 ± 4.3 L/min, p = 0.12), whereas non-survivors significantly deteriorated in PBF from 3.5 ± 1.0 to 1.0 ± 1.1 L/min (p = 0.029). Tidal volumes were significantly lower over time among the non-survivors, p = 0.047. Conclusions: In prolonged ECMO for pulmonary septic shock, CT was not found to be effective for the evaluation of pulmonary viability or recovery. This hypothesis-generating investigation supports echocardiography as a tool to predict pulmonary recovery via the assessment of PBF at the early to later stages of ECMO support.</p>}},
  author       = {{Falk, Lars and Lidegran, Marika and Diaz Ruiz, Sandra and Hultman, Jan and Broman, Lars Mikael}},
  issn         = {{2077-0383}},
  keywords     = {{extracorporeal membrane oxygenation; prognosis; prognostication; prolonged ECMO; pulmonary blood flow; sepsis; septic shock; tidal volume}},
  language     = {{eng}},
  number       = {{4}},
  publisher    = {{MDPI AG}},
  series       = {{Journal of Clinical Medicine}},
  title        = {{Severe Lung Dysfunction and Pulmonary Blood Flow during Extracorporeal Membrane Oxygenation}},
  url          = {{http://dx.doi.org/10.3390/jcm13041113}},
  doi          = {{10.3390/jcm13041113}},
  volume       = {{13}},
  year         = {{2024}},
}