Chest CT findings in severe acute respiratory distress syndrome requiring V-V ECMO: J-CARVE registry

• Published in: Journal of intensive care 2024-01, Vol.12 (1), p.5-10, Article 5
• Main Authors: Nishikimi, Mitsuaki, Ohshimo, Shinichiro, Fukumoto, Wataru, Hamaguchi, Jun, Matsumura, Kazuki, Fujizuka, Kenji, Hagiwara, Yoshihiro, Nakayama, Ryuichi, Bunya, Naofumi, Maruyama, Junichi, Abe, Toshikazu, Anzai, Tatsuhiko, Ogata, Yoshitaka, Naito, Hiromichi, Amemiya, Yu, Ikeda, Tokuji, Yagi, Masayuki, Furukawa, Yutaro, Taniguchi, Hayato, Yagi, Tsukasa, Katsuta, Ken, Konno, Daisuke, Suzuki, Ginga, Kawasaki, Yuki, Hattori, Noriyuki, Nakamura, Tomoyuki, Kondo, Natsuki, Kikuchi, Hitoshi, Kai, Shinichi, Ichiyama, Saaya, Awai, Kazuo, Takahashi, Kunihiko, Shime, Nobuaki
• Format: Article
• Language: English
• Subjects: Acute respiratory distress syndrome; Computed tomography; CT imaging; Data collection; Diagnostic imaging; Extracorporeal membrane oxygenation; In-hospital mortality; Japan; Lung diseases; Medical research; Medicine, Experimental; Mortality; Patients; Respiratory distress syndrome; Static lung compliance; Subcutaneous emphysema; Survival analysis; Traction bronchiectasis; United Kingdom
• ISSN: 2052-0492; 2052-0492
• DOI: 10.1186/s40560-023-00715-x

Chest computed tomography findings are helpful for understanding the pathophysiology of severe acute respiratory distress syndrome (ARDS). However, there is no large, multicenter, chest computed tomography registry for patients requiring veno-venous extracorporeal membrane oxygenation (V-V ECMO). The aim of this study was to describe chest computed tomography findings at V-V ECMO initiation and to evaluate the association between the findings and outcomes in severe ARDS. This multicenter, retrospective cohort study enrolled patients with severe ARDS on V-V ECMO, who were admitted to the intensive care units of 24 hospitals in Japan between January 1, 2012, and December 31, 2022. The primary outcome was 90-day in-hospital mortality. The secondary outcomes were the successful liberation from V-V ECMO and the values of static lung compliance. Among the 697 registry patients, of the 582 patients who underwent chest computed tomography at V-V ECMO initiation, 394 survived and 188 died. Multivariate Cox regression showed that traction bronchiectasis and subcutaneous emphysema increased the risk of 90-day in-hospital mortality (hazard ratio [95% confidence interval] 1.77 [1.19-2.63], p = 0.005 and 1.97 [1.02-3.79], p = 0.044, respectively). The presence of traction bronchiectasis was also associated with decreased successful liberation from V-V ECMO (odds ratio: 0.27 [0.14-0.52], p