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. 2024 Feb 16;13(4):1113.
doi: 10.3390/jcm13041113.

Severe Lung Dysfunction and Pulmonary Blood Flow during Extracorporeal Membrane Oxygenation

Lars Falk  1   2 , Marika Lidegran  3 , Sandra Diaz Ruiz  3   4   5 , Jan Hultman  1   2 , Lars Mikael Broman  1   2
Affiliations

Severe Lung Dysfunction and Pulmonary Blood Flow during Extracorporeal Membrane Oxygenation

Lars Falk et al. J Clin Med. .

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 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.

Keywords: extracorporeal membrane oxygenation; prognosis; prognostication; prolonged ECMO; pulmonary blood flow; sepsis; septic shock; tidal volume.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Patient selection. Inclusion: 15 years of age or older, ECMO support at ECMO Centre Karolinska between 2011 and 2017 with septic shock according to Sepsis 2, originating from pneumonia, and treated for >28 days. Patients were excluded if they received extracorporeal cardiopulmonary resuscitation or were partly treated with ECMO at another hospital. Abbreviations: ECPR, extracorporeal cardiopulmonary resuscitation; LoS, length of stay.
Figure 2
Figure 2
Interaction between survivors and non-survivors (mixed effects model) regarding pulmonary blood flow over time for the individual patients (dotted lines) and aggregated for the respective group (filled lines) (p = 0.00). The red color marks non-survivors, and the green color marks survivors. Abbreviations: ECMO, extracorporeal membrane oxygenation.
Figure 3
Figure 3
Interaction over time between survivors and non-survivors (mixed effects model) of tidal volume (mL) for the individual patients; red dotted lines indicate non-survivors and green dotted lines indicate survivors. Aggregated data are displayed for the respective group with filled lines (p = 0.047). Abbreviations: ECMO, extracorporeal membrane oxygenation.
Figure 4
Figure 4
Interaction over time between survivors and non-survivors (mixed effects model) of SOFA for the individual patients (dotted lines) and aggregated for the respective group (bold lines) (p = 0.03). The red color marks non-survivors, and the green color marks survivors. Abbreviations: SOFA, Sequential Organ Failure Assessment score; ECMO, extracorporeal membrane oxygenation.
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