Figure 1
Fig. 2
Fig. 3
Scoring system for chest radiographs for the extent and severity of opacities
| Assigned Score | |||||
|---|---|---|---|---|---|
| 0 | 1 | 2 | 3 | 4 | |
| Quality | Nondiagnostic | Suboptimal | Diagnostic | ||
| Localization (Each lung divided into upper, middle and lower zones) | None | One zone | Two zones | Three zones | |
| Severity (Each lung field divided into four quadrants) | None | One quadrant | Two quadrants | Three quadrants | Four quadrants |
| Opacity characteristics | No change from baseline | Hazy homogeneous opacities without obscuration of lung markings with or without air bronchograms | Confluent alveolar and/or interstitial opacities with obscuration of lung markings with or without air bronchograms | Increasing attenuation with obscuration of the mediastinal, hemidiaphragms, costophrenic sulcus margins | Complete Whiteout |
Baseline characteristics and outcomes among patients with and without the significant worsening in opacity score
| Significant worsening in opacity score | |||
|---|---|---|---|
| Variable | Yes (n=9) | No (n=24) | P-value† |
| Age | 56 (50-69) | 53.5 (14-66) | 0.11 |
| Male sex | 55.6% | 62.5% | 0.72 |
| Caucasian | 44.4% | 62.5% | 0.26 |
| Underlying diagnosis necessitating ECMO | |||
| Interstitial lung disease | 77.8% | 54.2% | |
| ARDS | 11.1% | 16.7% | 0.64 |
| Others | 11.1% | 29.1% | |
| Pre-ECMO PF ratio (mm Hg) | 99 (84-336) | 88 (64-164) | 0.31 |
| Co-morbid pulmonary hypertension | 33.3% | 16.7% | 0.36 |
| Pre-ECMO transfusion | 11.1% | 25% | 0.35 |
| Pre-ECMO pressors | 33.3% | 54.2% | 0.35 |
| Pre-ECMO use of inhaled nitric oxide | 88.9% | 62.5% | 0.18 |
| Pre-ECMO positive blood cultures | None | None | |
| VV-ECMO | 88.9% | 83.3% | 0.69 |
| Intended Bridge to LT | 77.8% | 70.8% | 0.69 |
| Post-ECMO transfusion | 88.9% | 79.2% | 0.52 |
| Post-ECMO pressors | 66.7% | 87.5% | 0.17 |
| Post-ECMO use of inhaled nitric oxide | 66.7% | 54.2% | 0.6 |
| Post-ECMO fluid balance day 1-3 (L) | +1.0 (-1.8 to +8.1) | +1.4 (-6.5 to +8.6) | 0.59 |
| Able to get out of bed on ECMO | 22.2% | 37.5% | 0.28 |
| Able to ambulate on ECMO | None | 20.8% | 0.1 |
| Successful bridge to LT | 57.1% (n=7) | 58.8% (n=17) | 0.94 |
| Successful bridge to recovery | None (n=2) | 57.1% (n=7) | 0.4 |
| Duration of ECMO | 5 (3-17) | 10 (4-47) | 0.047 |
| Hospital Survival | 55.5% | 58.3% | 1.0 |
Development of new organ dysfunction among patients with and without the significant worsening in opacity score
| Variable | Significant worsening in opacity score | Chi-square | |
|---|---|---|---|
| Yes | No | P-value | |
| (n=9) | (n=24) | ||
| Acute renal failure | 22.2% | 33.3% | 0.69 |
| Shock | 55.6 | 70.8 | 0.41 |
| Liver dysfunction | 11.1 | 29.2 | 0.28 |
| Hematologic dysfunction | 77.8 | 79.2 | 0.93 |