Severe Lung Dysfunction and Pulmonary Blood Flow during Extracorporeal Membrane Oxygenation

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Falk, LarsKarolinska Institutet,Karolinska Institute,Karolinska University Hospital (author)

Severe Lung Dysfunction and Pulmonary Blood Flow during Extracorporeal Membrane Oxygenation

Article/chapterEnglish2024

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2024

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LIBRIS-ID:oai:lup.lub.lu.se:c853c46c-ee52-4d98-9890-4619024083a3
https://lup.lub.lu.se/record/c853c46c-ee52-4d98-9890-4619024083a3URI
https://doi.org/10.3390/jcm13041113DOI
http://kipublications.ki.se/Default.aspx?queryparsed=id:155092547URI

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Language:English
Summary in:English

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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.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Anestesi och intensivvård hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Anesthesiology and Intensive Care hsv//eng
extracorporeal membrane oxygenation
prognosis
prognostication
prolonged ECMO
pulmonary blood flow
sepsis
septic shock
tidal volume

Added entries (persons, corporate bodies, meetings, titles ...)

Lidegran, MarikaKarolinska Institutet,Karolinska University Hospital (author)
Diaz Ruiz, SandraKarolinska Institutet,Karolinska Institute,Lund University,Lunds universitet,Diagnostisk radiologi, Malmö,Forskargrupper vid Lunds universitet,LUCC: Lunds universitets cancercentrum,Övriga starka forskningsmiljöer,Radiology Diagnostics, Malmö,Lund University Research Groups,LUCC: Lund University Cancer Centre,Other Strong Research Environments,Karolinska University Hospital(Swepub:lu)ront-sdi (author)
Hultman, JanKarolinska Institute,Karolinska University Hospital (author)
Broman, Lars MikaelKarolinska Institute,Karolinska University Hospital (author)
Karolinska InstituteKarolinska University Hospital (creator_code:org_t)

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In:Journal of Clinical Medicine13:42077-0383

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