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

Autor: Collins PD; Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK., Giosa L; Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.; Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, London, UK., Kathar S; Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK., Camarda V; Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK., Palmesino F; Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK., Eshwar D; Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK., Barrett NA; Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.; Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, London, UK., Retter A; Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK., Vasques F; Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK., Sanderson B; Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK., Mak SM; Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK., Rose L; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK., Camporota L; Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. luigi.camporota@gstt.nhs.uk.; Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, London, UK. luigi.camporota@gstt.nhs.uk.
Jazyk: angličtina
Zdroj: Annals of intensive care [Ann Intensive Care] 2023 Sep 26; Vol. 13 (1), pp. 90. Date of Electronic Publication: 2023 Sep 26.
DOI: 10.1186/s13613-023-01187-w
Abstrakt: 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.
(© 2023. La Société de Réanimation de Langue Francaise = The French Society of Intensive Care (SRLF).)
Databáze: MEDLINE
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