Chest and abdominal CT during extracorporeal membrane oxygenation: Clinical benefits in diagnosis and treatment.
OBJECTIVE
This study aims to evaluate the clinical usefulness of thoracic and abdominal computed tomography (CT) as an adjunct to bedside diagnostic imaging in patients on extracorporeal membrane oxygenation (ECMO) therapy because of severe acute respiratory failure.


METHODS
Imaging records for 118 consecutive thoracic and abdominal CT examinations performed in 63 patients (22 neonates, 15 children, and 26 adults) on ECMO therapy during an 8-year period were retrospectively reviewed. Reported CT findings were compared with concurrent bedside radiographs and ultrasounds. The clinical importance and effect on treatment of each CT finding was determined by reviewing the medical records.


RESULTS
CT showed 30 clinically important complications in 20 different patients that directly impacted on the treatment, but were not diagnosed with bedside imaging. Of the 30 complications, 15 (50%) were surgically treated, 11 (37%) required percutaneous invasive procedures, and 4 (13%) were managed conservatively. Despite the serious complications, 13 of 20 patients (65%) survived.


CONCLUSIONS
Both chest and abdominal CT have an important clinical role in patients on ECMO therapy because of acute respiratory failure, as a complement to bedside imaging, to exclude or show complications and expedite early invasive treatment, when needed.
Lidegran
Marika K
MK
Department of Pediatric Radiology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Karolinska Institute SE-171 76, Stockholm, Sweden. marika.lidegran@karolinska.se
Ringertz
Hans G
HG
Frenckner
Björn P
BP
Lindén
Viveka B
VB
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004322:Drainage; D004452:Echocardiography; D015199:Extracorporeal Membrane Oxygenation; D006470:Hemorrhage / Q000000981:diagnostic imaging; D006491:Hemothorax / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D011014:Pneumonia / Q000000981:diagnostic imaging; D019095:Point-of-Care Systems; D011860:Radiography, Abdominal / Q000379:methods*; D013902:Radiography, Thoracic / Q000379:methods*; D012131:Respiratory Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D012189:Retrospective Studies; D018805:Sepsis / Q000000981:diagnostic imaging; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome