Extracorporeal membrane oxygenation in adults: radiographic findings and correlation of lung opacity with patient mortality.

Abstract

To describe the radiographic appearance of extracorporeal membrane oxygenation (ECMO) in adults and to correlate lung opacity with physiologic parameters and mortality. Chest radiographs of 50 adults treated with ECMO were reviewed; pre-ECMO radiographs were available in 35 patients. Lung opacity was assigned a score of 0-4. Complications of ECMO seen at chest radiography were recorded. The lung opacity scores of the first post-ECMO radiographs were higher than those of the pre-ECMO radiographs in 17 of 35 patients (P = .0005). Maximum opacity score was significantly lower for patients who survived compared with those who died (P = .001). Twelve of 14 patients (86%) with a maximum opacity score of 4 died, compared with eight of 29 patients (28%) with a maximum score of 3. Sixteen of 26 patients (61%) with evidence of baro-trauma died, compared with six of 24 patients (25%) without pneumothorax (P = .02). Four patients developed hemothorax. Lung opacity increases immediately after initiation of ECMO. Increased opacity corresponds to decreased pulmonary function, and severe opacity correlates strongly with mortality.