Radiation Exposure in Extracorporeal Life Support

Area of Science:

• Radiology
• Medical Physics
• Critical Care Medicine

Background:

• Extracorporeal membrane oxygenation (ECMO) necessitates frequent radiologic imaging.
• Patient radiation exposure during ECMO is a growing concern, potentially exceeding established safety limits.

Purpose of the Study:

• To evaluate the cumulative effective dose (CED) of ionizing radiation in adult ECMO patients.
• To compare radiation exposure against International Commission of Radiological Protection (ICRP) recommendations.
• To identify sources contributing to high radiation doses during ECMO and hospitalization.

Main Methods:

• Retrospective observational study of 306 adult ECMO admissions (2016-2018).
• Calculation of CED based on reference values for radiologic studies.
• Analysis of radiation exposure during ECMO and entire hospitalization periods.

Main Results:

• 4.5% of patients exceeded the 5-year ICRP cumulative limit (100 mSv) during ECMO; 14.7% exceeded it over the entire hospitalization.
• Median CED during ECMO was 2.3 mSv, contributing 13% to the median hospitalization CED of 17.4 mSv.
• Computer tomography (CT) and interventional radiology (IR) accounted for over 88% of CED during ECMO and 89% during hospitalization.

Conclusions:

• A significant proportion of ECMO patients receive substantial radiation doses, with CT and IR being major contributors.
• Current radiation exposure levels highlight the need for revised guidelines and mitigation strategies for ECMO patients.
• Longer hospitalization duration correlates with increased cumulative effective dose, emphasizing the importance of radiation management throughout the patient's stay.