Clinical impact of screening computed tomography in extracorporeal membrane oxygenation : a retrospective cohort study
© 2023. La Société de Réanimation de Langue Francaise = The French Society of Intensive Care (SRLF)..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:13 |
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| Enthalten in: |
Annals of intensive care - 13(2023), 1 vom: 26. Sept., Seite 90 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Collins, Patrick D [VerfasserIn] |
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| Links: |
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| Themen: |
Acute |
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| Anmerkungen: |
Date Revised 23.11.2023 published: Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1186/s13613-023-01187-w |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM362472750 |
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| 100 | 1 | |a Collins, Patrick D |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Clinical impact of screening computed tomography in extracorporeal membrane oxygenation |b a retrospective cohort study |
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| 500 | |a published: Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2023. La Société de Réanimation de Langue Francaise = The French Society of Intensive Care (SRLF). | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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) | ||
| 520 | |a CONCLUSIONS: Screening CT frequently identifies extrapulmonary findings of clinical significance. Newly detected intracranial haemorrhage, cerebral infarction and colitis were associated with increased ICU mortality | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Acute | |
| 650 | 4 | |a Computed tomography | |
| 650 | 4 | |a Respiratory distress syndrome | |
| 650 | 4 | |a Veno-venous extracorporeal membrane oxygenation | |
| 700 | 1 | |a Giosa, Lorenzo |e verfasserin |4 aut | |
| 700 | 1 | |a Kathar, Sushil |e verfasserin |4 aut | |
| 700 | 1 | |a Camarda, Valentina |e verfasserin |4 aut | |
| 700 | 1 | |a Palmesino, Filippo |e verfasserin |4 aut | |
| 700 | 1 | |a Eshwar, Darshan |e verfasserin |4 aut | |
| 700 | 1 | |a Barrett, Nicholas A |e verfasserin |4 aut | |
| 700 | 1 | |a Retter, Andrew |e verfasserin |4 aut | |
| 700 | 1 | |a Vasques, Francesco |e verfasserin |4 aut | |
| 700 | 1 | |a Sanderson, Barnaby |e verfasserin |4 aut | |
| 700 | 1 | |a Mak, Sze M |e verfasserin |4 aut | |
| 700 | 1 | |a Rose, Louise |e verfasserin |4 aut | |
| 700 | 1 | |a Camporota, Luigi |e verfasserin |4 aut | |
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