![]() A team of investigators (PC, LG, SK, VC, FP, DE) (blinded to outcome) reviewed all admission routine screening CT reports in the Picture and Archive Communication System (PACS Advanced Data Systems Corporation, Paramus, New Jersey, USA) and identified incidental extrapulmonary findings according to the radiology report at the time of CT acquisition. ![]() Briefly, routine screening CT scans were contemporaneously reported by (1) a radiology registrar (with a minimum of 4 year postgraduate experience) and (2) a consultant radiologist. Figure 1 outlines the standard processes of care at our centre, and the retrospective screening methods. This was a retrospective, observational study. We excluded patients who received Veno-Arterial or hybrid ECMO modes. We included patients admitted to the adult ECMO ICU at St Thomas’ Hospital, London, UK between January 2011 and September 2021, who: (1) received V-V ECMO for severe refractory but potentially reversible respiratory failure and (2) had a post-cannulation routine screening CT of the head (non-contrast), abdomen and pelvis (with contrast) performed at our centre. We hypothesized that extrapulmonary findings on screening CT would affect medical management and be associated with ECMO survival. The aim of this retrospective analysis of admission screening CT findings after cannulation for V-V ECMO was to (1) report the prevalence of extrapulmonary findings and (2) evaluate their impact on clinical management and ICU mortality. In contrast, the systematic use of an extrapulmonary screening CT in V-V ECMO patients is less common internationally despite data suggesting a high diagnostic yield. Thoracic CT has recognized diagnostic and prognostic yield in the management of patients with severe respiratory failure. Īt our centre, one of six specialized severe respiratory failure centres commissioned by the National Health Service in the UK to provide V-V ECMO, the routine care of patients undergoing ECMO has included a comprehensive screening computed tomography (CT) of the head, chest, abdomen and pelvis upon return to the hospital following mobile ECMO retrieval (1–6 h post ECMO cannulation). Consequently, there is variation in practice and outcomes among centres, which may reflect different screening procedures and processes of care. However, there is limited evidence regarding the use of routine screening of extrapulmonary pathology on V-V ECMO cannulation. These patients may have extrapulmonary causes or consequences of their critical illness. Veno-Venous Extracorporeal Membrane Oxygenation (V-V ECMO) is used to support patients with severe respiratory failure, such as the acute respiratory distress syndrome (ARDS). Newly detected intracranial haemorrhage, cerebral infarction and colitis were associated with increased ICU mortality. Screening CT frequently identifies extrapulmonary findings of clinical significance. 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). ![]() ![]() 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%). ECMO ICU length of stay was 19 days (IQR 12–23) ICU mortality at the ECMO centre was 18.9%. Of the 833 patients receiving V-V ECMO, 761 underwent routine admission CT (91.4%). We used multivariable logistic regression and Kaplan–Meier curves to evaluate associations between extrapulmonary findings and ECMO ICU mortality. Demographics, admission physiological and laboratory data, clinical decision-making following CT and ECMO ICU mortality were recorded from the electronic medical record. CT findings identified by the attending consultant radiologist were extracted. Retrospective analysis (2011–2021) of admission screening CT including head, abdomen and pelvis with contrast of consecutive patients on initiation of V-V ECMO. We hypothesized that extrapulmonary findings would influence clinical management and outcome. We aimed to identify the prevalence of extrapulmonary findings on screening CT following V-V ECMO initiation. 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.
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