Lung Ultrasound in Predicting Outcomes in Patients with COVID-19 Treated with Extracorporeal Membrane Oxygenation

Abstract

Pulmonary involvement due to SARS-CoV-2 infection can lead to acute respiratory distress syndrome in patients with COVID-19. Consequently, pulmonary imaging is crucial for management of COVID-19. This study aimed to evaluate the prognostic value of lung ultrasound (LUS) with a handheld ultrasound device (HHUD) in patients with COVID-19 treated with extracorporeal membrane oxygenation (ECMO). Therefore, patients underwent LUS with a HHUD every two days until they were either discharged from the intensive care unit or died. The study was conducted at the University Hospital of Bonn’s anesthesiological intensive care ward from December 2020 to August 2021. A total of 33 patients (median [IQR]: 56.0 [53–60.5] years) were included. A high LUS score was associated with a decreased P/F ratio (repeated measures correlation [rmcorr]: −0.26; 95% CI: −0.34, −0.15; p < 0.001), increased extravascular lung water, defined as fluid accumulation in the pulmonary interstitium and alveoli (rmcorr: 0.11; 95% CI: 0.01, 0.20; p = 0.030), deteriorated electrolyte status (base excess: rmcorr: 0.14; 95% CI: 0.05, 0.24; p = 0.004; pH: rmcorr: 0.12; 95% CI: 0.03, 0.21; p = 0.001), and decreased pulmonary compliance (rmcorr: −0.10; 95% CI: −0.20, −0.01; p = 0.034). The maximum LUS score was lower in survivors (median difference [md]: −0.35; 95% CI: −0.55, −0.06; p = 0.006). A cutoff value for non-survival was calculated at a LUS score of 2.63. At the time of maximum LUS score, P/F ratio (md: 1.97; 95% CI: 1.12, 2.76; p < 0.001) and pulmonary compliance (md: 18.67; 95% CI: 3.33, 37.15; p = 0.018) were higher in surviving patients. In conclusion, LUS with a HHUD enables continuous evaluation of cardiopulmonary function in COVID-19 patients receiving ECMO support therapy and provides prognostic value in determining the patients’ likelihood of survival.

A Novel Automatic Algorithm to Support Lung Ultrasound Non-Expert Physicians in Interstitial Pneumonia Evaluation: A Single-Center Study

“…Lastly, the study pointed out that in patients with reduced DLCO, Lung Staging classifications were significantly higher compared to those with preserved DLCO (reduced median 1 [1][2] vs. preserved 0 [0-1], p = 0.001). The overlap in results with the LUS score in this subgroup underscores the diagnostic efficacy of Lung Staging (reduced median 18 [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] vs. preserved 5.5 [2][3][4][5][6][7][8][9], p = 0.035). This is particularly true in cases where conventional lung function tests may be inconclusive, supporting a pneumologist nonexpert in LUS to have the imaging evaluation of ILD severity (Figure 6).…”

“…However, due to technical limitations, only subpleural spaces may be evaluated with LUS. Even if none of the LUS features is pathognomonic for a specific disease, much evidence supports its clinical value to evaluate treatment response both in intensive care and internal medicine departments [5][6][7], detect signs of pulmonary involvement, and disease progression or regression.…”

Advanced Respiratory Monitoring during Extracorporeal Membrane Oxygenation

“…LUS can also quantify lung recruitment in ARDS patients undergoing ECMO [68]; this is of clinical interest since patients with a high potential for lung recruitment have a shorter ICU stay and ECMO duration [69]. In addition, the maximum LUS value is highly predictive of the prognosis of COVID-19 patients [70]. Ultimately, LUS offers the benefit of decreasing healthcare expenses for patients with ARDS, and it does not require the transport of patients to radiological departments for chest CT scans, thereby reducing the associated risks [71].…”