Routine CT scanning of patients retrieved to a tertiary centre on veno-venous extracorporeal membrane oxygenation: a retrospective risk benefit analysis

Richmond, Kate M.; Warburton, Katharine G.; Finney, Simon J.; Shah, Sachin J; Reddi, Benjamin

doi:10.1177/0267659118763266

Cited by 6 publications

(10 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…About 37% of the lesions were diagnosed from a CT scan performed in the absence of neurological symptoms. Low utilization of neuroimaging as a contributor to underreporting of ECMO-associated intracranial pathologies has been suggested in several previous studies 3,4,[17][18][19] . Thus, the incidence of BI in adult ECMO patients may be higher than previously estimated.…”

Section: Discussionmentioning

confidence: 93%

Predictors of brain infarction in adult patients on extracorporeal membrane oxygenation: an observational cohort study

Iacobelli

Fletcher‐Sandersjöö

Lindblad

et al. 2021

Sci Rep

View full text Add to dashboard Cite

Non-hemorrhagic brain infarction (BI) is a recognized complication in adults treated with extracorporeal membrane oxygenation (ECMO) and associated with increased mortality. However, predictors of BI in these patients are poorly understood. The aim of this study was to identify predictors of BI in ECMO-treated adult patients. We conducted an observational cohort study of all adult patients treated with venovenous or venoarterial (VA) ECMO at our center between 2010 and 2018. The primary endpoint was a computed tomography (CT) verified BI. Logistic regression models were employed to identify BI predictors. In total, 275 patients were included, of whom 41 (15%) developed a BI. Pre-ECMO Simplified Acute Physiology Score III, pre-ECMO cardiac arrest, VA ECMO and conversion between ECMO modes were identified as predictors of BI. In the multivariable analysis, VA ECMO demonstrated independent risk association. VA ECMO also remained the independent BI predictor in a sub-group analysis excluding patients who did not undergo a head CT scan during ECMO treatment. The incidence of BI in adult ECMO patients may be higher than previously believed and is independently associated with VA ECMO mode. Larger prospective trials are warranted to validate these findings and ascertain their clinical significance.

show abstract

Section: Discussionmentioning

confidence: 93%

Predictors of brain infarction in adult patients on extracorporeal membrane oxygenation: an observational cohort study

Iacobelli

Fletcher‐Sandersjöö

Lindblad

et al. 2021

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Our previous experience has shown that computed tomography (CT) scanning is safe and feasible for patients on ECMO [19]. However, this data also showed that the effect of lung or abdominal scanning was modest on clinical decision-making.…”

Section: Imagingmentioning

confidence: 91%

SARS-CoV-2 and ECMO: early results and experience

Akhtar

Olusanya

Baladía

et al. 2020

Indian J Thorac Cardiovasc Surg

Self Cite

View full text Add to dashboard Cite

Introduction In this paper, we describe our experience and early outcomes with critically unwell severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients who required extracorporeal membrane oxygenation (ECMO). We present our standard practices around ECMO decision-making, retrieval, cannulation, ventilation, anticoagulation, tracheostomy, imaging and steroids. Methods A retrospective cohort study using data from the hospital notes on all SARS-CoV-2 patients who required extracorporeal support at St Bartholomew's Hospital between 1 March 2020 and 31 July 2020. In total, this included 18 patients over this time period. Results In total, 18 patients were managed with extracorporeal support and of these 14 survived (78%) with 4 deaths (22%). The mean duration from hospital admission to intubation was 4.1 ± 3.4 days, mean time from intubation to ECMO 2.3 ± 2 days and mean run on ECMO 17.7 ± 9.4 days. Survivor mean days from intubation to extubation was 20.6 ± 9.9 days and survivor mean days from intubation to tracheostomy decannulation 46.6 ± 15.3 days. Time from hospital admission to discharge in survivors was a mean of 57.2 ± 25.8 days. Of the patients requiring extracorporeal support, the initial mode was veno-venous (VV) in 15 (83%), veno-arterial (VA) in 2 (11%) and veno-venous-arterial (VVA) in 1 (6%). On VV extracorporeal support, 2 (11%) required additional VVA. Renal replacement therapy was required in 10 (56%) of the patients. Anticoagulation target anti-Xa of 0.2-0.4 was set, with 10 (56%) patients having a deep vein thrombosis or pulmonary embolism detected and 2 (11%) patients suffering an intracranial haemorrhage. Tracheostomy was performed in 9 (50%) of the patients and high-dose methylprednisolone was given to 7 (39%) of the patients. Conclusion In our cohort of patients with severe SARS-CoV-2 respiratory failure, a long period of invasive ventilation and extracorporeal support was required but achieving good outcomes despite this. There was a significant burden of thromboembolic disease and renal injury. A significant proportion of patients required tracheostomy and steroids to facilitate weaning.

show abstract

“…It is likely that a routine total body CT is even less common. Two previous single-centre studies have reported the findings from routine use of whole-body CT but had substantially smaller sample sizes ( N = 65 [ 10 ], N = 198 [ 11 ]) with one cohort that did not routinely utilize intravenous contrast [ 11 ]. Several other single centre studies reported prevalence and clinical impact of CT imaging during treatment with V-V ECMO, but do not use a routine screening CT, have smaller sample sizes, and contain mixed adult and pediatric populations [ 17 – 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Thoracic CT has recognized diagnostic and prognostic yield in the management of patients with severe respiratory failure [ 8 , 9 ]. In contrast, the systematic use of an extrapulmonary screening CT in V-V ECMO patients is less common internationally despite data suggesting a high diagnostic yield [ 10 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical impact of screening computed tomography in extracorporeal membrane oxygenation: a retrospective cohort study

Collins,

Giosa,

Kathar

et al. 2023

Ann. Intensive Care

View full text Add to dashboard Cite

Background Data on the prevalence and clinical impact of extrapulmonary findings at screening computed tomography (CT) on initiation of veno-venous extracorporeal membrane oxygenation (V-V ECMO) are limited. We aimed to identify the prevalence of extrapulmonary findings on screening CT following V-V ECMO initiation. We hypothesized that extrapulmonary findings would influence clinical management and outcome. Methods Retrospective analysis (2011–2021) of admission screening CT including head, abdomen and pelvis with contrast of consecutive patients on initiation of V-V ECMO. CT findings identified by the attending consultant radiologist were extracted. Demographics, admission physiological and laboratory data, clinical decision-making following CT and ECMO ICU mortality were recorded from the electronic medical record. We used multivariable logistic regression and Kaplan–Meier curves to evaluate associations between extrapulmonary findings and ECMO ICU mortality. Results Of the 833 patients receiving V-V ECMO, 761 underwent routine admission CT (91.4%). ECMO ICU length of stay was 19 days (IQR 12–23); ICU mortality at the ECMO centre was 18.9%. An incidental extrapulmonary finding was reported in 227 patients (29.8%), leading to an invasive procedure in 12/227 cases (5.3%) and a change in medical management (mainly in anticoagulation strategy) in 119/227 (52.4%). Extrapulmonary findings associated with mortality were intracranial haemorrhage (OR 2.34 (95% CI 1.31–4.12), cerebral infarction (OR 3.59 (95% CI 1.26–9.86) and colitis (OR 2.80 (95% CI 1.35–5.67). Conclusions Screening CT frequently identifies extrapulmonary findings of clinical significance. Newly detected intracranial haemorrhage, cerebral infarction and colitis were associated with increased ICU mortality.

show abstract

Routine CT scanning of patients retrieved to a tertiary centre on veno-venous extracorporeal membrane oxygenation: a retrospective risk benefit analysis

Abstract: Prospective studies should evaluate whether routine CT impacts outcome.

Cited by 6 publications

References 22 publications

Predictors of brain infarction in adult patients on extracorporeal membrane oxygenation: an observational cohort study

Predictors of brain infarction in adult patients on extracorporeal membrane oxygenation: an observational cohort study

SARS-CoV-2 and ECMO: early results and experience

Clinical impact of screening computed tomography in extracorporeal membrane oxygenation: a retrospective cohort study

Contact Info

Product

Resources

About