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Published on: January 17, 2025
Multi-Lobar Atelectasis in Children Receiving Venoarterial Extracorporeal Membrane Oxygenation for Cardiac
Maria Abou Nader1, Matthew L Friedman2, Christopher W Mastropietro2
1Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana. abounader.maria@gmail.com.
Insights
Multi-lobar atelectasis frequently complicates pediatric cardiac extracorporeal membrane oxygenation (ECMO), leading to worse outcomes. Male sex and re-initiation of ECMO increase risk, while pre-ECMO ventilation may be protective.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular surgery
- Respiratory physiology
Background:
- Respiratory complications are frequent in pediatric patients requiring venoarterial extracorporeal membrane oxygenation (VA ECMO) for cardiac indications.
- Early multi-lobar atelectasis is a significant concern in this vulnerable population.
Purpose of the Study:
- To determine the incidence and characteristics of multi-lobar atelectasis developing early during VA ECMO in pediatric cardiac patients.
- To identify factors associated with the occurrence of multi-lobar atelectasis.
Main Methods:
- A single-center retrospective review of pediatric VA ECMO cases from 2014-2019.
- Analysis of daily chest radiographs for up to 5 days of VA ECMO support.
- Multivariable logistic regression to identify independent risk factors for multi-lobar atelectasis.
Main Results:
- Multi-lobar atelectasis occurred in 30% of VA ECMO runs, associated with longer support duration and lower hospital survival (51% vs 77%).
- Independent predictors for multi-lobar atelectasis included a subsequent ECMO run during the same admission (OR 5.4).
- For isolated left lung collapse, male sex (OR 8.9) and subsequent ECMO run were associated, while pre-ECMO ventilation (OR 0.22) appeared protective.
Conclusions:
- Multi-lobar atelectasis is a common complication in pediatric cardiac VA ECMO, associated with poorer outcomes.
- Risk factors include male sex and repeat ECMO runs; pre-ECMO mechanical ventilation may offer protection.
Background:
Respiratory complications are common in patients who require venoarterial (VA) extracorporeal membrane oxygenation (ECMO) for cardiac indications. We aimed to examine the frequency and characteristics of patients who develop multi-lobar atelectasis early in the course of VA ECMO and to identify factors associated with its occurrence.
Methods:
We performed a single-center retrospective review of consecutive pediatric subjects on VA ECMO in the cardiovascular ICU from 2014 to 2019. Chest radiographs before VA ECMO initiation and daily for up to 5 d of VA ECMO support were reviewed. Multi-lobar atelectasis was defined as the collapse of ≥2 lobes of the same lung. Patients with multi-lobar atelectasis before or immediately after VA ECMO cannulation were excluded. Bivariate comparisons and multivariable logistic regression analyses were performed to identify factors independently associated with lung collapse. Results of the multivariable analysis are provided as odds ratio (OR) with 95% CI.
Results:
We reviewed 119 VA ECMO runs in 101 unique subjects. Multi-lobar atelectasis occurred in 36 runs (30%), with an isolated collapse of the left lung occurring most frequently (no. runs = 20). VA ECMO runs complicated by multi-lobar atelectasis were significantly longer and associated with lower hospital survival (51% vs 77%, survival in subjects without multi-lobar atelectasis; P = .01). Multivariable logistic regression analysis identified a subsequent ECMO run during the same admission to be independently associated with multi-lobar atelectasis (OR 5.4, 95% CI 1.2-21.5). Subanalysis of the subjects with isolated left lung collapse revealed male sex (OR 8.9, 95% CI 1.6-48.2) and subsequent ECMO run during the same admission (OR 4.0, 95% CI 1.2-13.6) to be independently associated with this complication, and mechanical ventilation at least 12 h before ECMO may be protective (OR 0.22, 95% CI 0.07-0.76).
Conclusions:
Multi-lobar atelectasis commonly occurred in children who were receiving VA ECMO for cardiac failure and was associated with worse outcomes. Male patients, a subsequent VA ECMO run during the same hospitalization, and patients in whom mechanical ventilation was initiated shortly before ECMO cannulation may be at increased risk for this complication.
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