Autopsy Histopathologic Lung Findings in Patients Treated With Extracorporeal Membrane Oxygenation

Area of Science:

• Pulmonary Pathology
• Critical Care Medicine
• Cardiopulmonary Support

Background:

• Extracorporeal membrane oxygenation (ECMO) use is rising for respiratory and cardiac failure.
• Limited data exists on lung histopathology in ECMO patients.
• Understanding these changes is crucial for improving ECMO therapy and outcomes.

Purpose of the Study:

• To investigate pulmonary histopathologic findings in ECMO recipients.
• To determine if lung changes offer insights for preventing complications and improving outcomes.
• To compare findings between venovenous (VV) and venoarterial (VA) ECMO.

Main Methods:

• Retrospective autopsy study of lung tissues.
• Included VV ECMO, VA ECMO, and non-ECMO acute respiratory distress syndrome (ARDS) patients.
• Data collected from 2008-2020 at Silesia Center for Heart Diseases.

Main Results:

• Common findings: bronchopneumonia (53.0%), interstitial edema (48.2%), diffuse alveolar damage (DAD; 38.6%), hemorrhagic infarct (33.7%), pulmonary hemorrhage (30.1%).
• DAD correlated with longer ECMO duration and hospital stay.
• VV ECMO predicted DAD; however, 32.3% of VA ECMO patients also showed DAD.

Conclusions:

• DAD is prevalent in VV ECMO, but also present in one-third of VA ECMO patients.
• Pulmonary histopathology in VA ECMO patients suggests ARDS-like changes.
• Consideration of protective lung ventilation is recommended for VA ECMO patients with DAD.