Extracorporeal membrane oxygenation in adults: Radiographic findings and correlation of lung opacity with patient mortality

PURPOSE: To describe the radiographic appearance of extracorporeal membrane oxygenation (ECMO) in adults and to correlate lung opacity with physiologic parameters and mortality. MATERIALS AND METHODS: Chest radiographs of 50 adults treated with ECMO were reviewed; pre-ECMO radiographs were available in 35 patients. Lung opacity was assigned a score of 0-4. Complications of ECMO seen at chest radiography were recorded. RESULTS: The lung opacity scores of the first post-ECMO radiographs were higher than those of the pre-ECMO radiographs in 17 of 35 patients (P =.0005). Maximum opacity score was significantly lower for patients who survived compared with those who died (P =.001). Twelve of 14 patients (86%) with a maximum opacity score of 4 died, compared with eight of 29 patients (28%) with a maximum score of 3. Sixteen of 26 patients (61%) with evidence of barotrauma died, compared with six of 24 patients (25%) without pneumothorax (P =.02). Four patients developed hemothorax. CONCLUSION: Lung opacity increases immediately after initiation of ECMO. Increased opacity corresponds to decreased pulmonary function, and severe opacity correlates strongly with mortality.