Effects of Extracorporeal Membrane Oxygenation Initiation on Oxygenation and Pulmonary Opacities
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Jan 29, 2021
About this article
Article Category: Research Article
Published Online: Jan 29, 2021
Page range: 6 - 13
Received: Jul 09, 2020
Accepted: Oct 27, 2020
DOI: https://doi.org/10.2478/jccm-2020-0040
Keywords
© 2021 Kiran Batra, Manish Mohanka, Srinivas Bollineni, Vaidehi Kaza, Prabhakar Rajiah, Yin Xi, Amy Hackmann, Michael Wait, Fernando Torres, Amit Banga, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Figure 1
Fig. 2
Fig. 3
Scoring system for chest radiographs for the extent and severity of opacities
| Assigned Score | |||||
|---|---|---|---|---|---|
| 0 | 1 | 2 | 3 | 4 | |
| Quality | Nondiagnostic | Suboptimal | Diagnostic | ||
| Localization (Each lung divided into upper, middle and lower zones) | None | One zone | Two zones | Three zones | |
| Severity (Each lung field divided into four quadrants) | None | One quadrant | Two quadrants | Three quadrants | Four quadrants |
| Opacity characteristics | No change from baseline | Hazy homogeneous opacities without obscuration of lung markings with or without air bronchograms | Confluent alveolar and/or interstitial opacities with obscuration of lung markings with or without air bronchograms | Increasing attenuation with obscuration of the mediastinal, hemidiaphragms, costophrenic sulcus margins | Complete Whiteout |
Baseline characteristics and outcomes among patients with and without the significant worsening in opacity score
| Significant worsening in opacity score | |||
|---|---|---|---|
| Variable | Yes (n=9) | No (n=24) | P-value† |
| Age | 56 (50-69) | 53.5 (14-66) | 0.11 |
| Male sex | 55.6% | 62.5% | 0.72 |
| Caucasian | 44.4% | 62.5% | 0.26 |
| Underlying diagnosis necessitating ECMO | |||
| Interstitial lung disease | 77.8% | 54.2% | |
| ARDS | 11.1% | 16.7% | 0.64 |
| Others | 11.1% | 29.1% | |
| Pre-ECMO PF ratio (mm Hg) | 99 (84-336) | 88 (64-164) | 0.31 |
| Co-morbid pulmonary hypertension | 33.3% | 16.7% | 0.36 |
| Pre-ECMO transfusion | 11.1% | 25% | 0.35 |
| Pre-ECMO pressors | 33.3% | 54.2% | 0.35 |
| Pre-ECMO use of inhaled nitric oxide | 88.9% | 62.5% | 0.18 |
| Pre-ECMO positive blood cultures | None | None | |
| VV-ECMO | 88.9% | 83.3% | 0.69 |
| Intended Bridge to LT | 77.8% | 70.8% | 0.69 |
| Post-ECMO transfusion | 88.9% | 79.2% | 0.52 |
| Post-ECMO pressors | 66.7% | 87.5% | 0.17 |
| Post-ECMO use of inhaled nitric oxide | 66.7% | 54.2% | 0.6 |
| Post-ECMO fluid balance day 1-3 (L) | +1.0 (-1.8 to +8.1) | +1.4 (-6.5 to +8.6) | 0.59 |
| Able to get out of bed on ECMO | 22.2% | 37.5% | 0.28 |
| Able to ambulate on ECMO | None | 20.8% | 0.1 |
| Successful bridge to LT | 57.1% (n=7) | 58.8% (n=17) | 0.94 |
| Successful bridge to recovery | None (n=2) | 57.1% (n=7) | 0.4 |
| Duration of ECMO | 5 (3-17) | 10 (4-47) | 0.047 |
| Hospital Survival | 55.5% | 58.3% | 1.0 |
Development of new organ dysfunction among patients with and without the significant worsening in opacity score
| Variable | Significant worsening in opacity score | Chi-square | |
|---|---|---|---|
| Yes | No | P-value | |
| (n=9) | (n=24) | ||
| Acute renal failure | 22.2% | 33.3% | 0.69 |
| Shock | 55.6 | 70.8 | 0.41 |
| Liver dysfunction | 11.1 | 29.2 | 0.28 |
| Hematologic dysfunction | 77.8 | 79.2 | 0.93 |