Lidegran Marika K, Ringertz Hans G, Frenckner Björn P, Lindén Viveka B
Department of Pediatric Radiology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Karolinska Institute SE-171 76, Stockholm, Sweden.
Acad Radiol. 2005 Mar;12(3):276-85. doi: 10.1016/j.acra.2004.11.027.
This study aims to evaluate the clinical usefulness of thoracic and abdominal computed tomography (CT) as an adjunct to bedside diagnostic imaging in patients on extracorporeal membrane oxygenation (ECMO) therapy because of severe acute respiratory failure.
Imaging records for 118 consecutive thoracic and abdominal CT examinations performed in 63 patients (22 neonates, 15 children, and 26 adults) on ECMO therapy during an 8-year period were retrospectively reviewed. Reported CT findings were compared with concurrent bedside radiographs and ultrasounds. The clinical importance and effect on treatment of each CT finding was determined by reviewing the medical records.
CT showed 30 clinically important complications in 20 different patients that directly impacted on the treatment, but were not diagnosed with bedside imaging. Of the 30 complications, 15 (50%) were surgically treated, 11 (37%) required percutaneous invasive procedures, and 4 (13%) were managed conservatively. Despite the serious complications, 13 of 20 patients (65%) survived.
Both chest and abdominal CT have an important clinical role in patients on ECMO therapy because of acute respiratory failure, as a complement to bedside imaging, to exclude or show complications and expedite early invasive treatment, when needed.
本研究旨在评估胸部和腹部计算机断层扫描（CT）作为严重急性呼吸衰竭患者体外膜肺氧合（ECMO）治疗床边诊断成像辅助手段的临床实用性。
回顾性分析了8年间63例接受ECMO治疗患者（22例新生儿、15例儿童和26例成人）连续进行的118次胸部和腹部CT检查的影像记录。将报告的CT检查结果与同期床边X光片和超声检查结果进行比较。通过查阅病历确定每个CT检查结果对治疗的临床重要性和影响。
CT显示20例不同患者出现30种对治疗有直接影响的临床重要并发症，但床边成像未诊断出这些并发症。在这30种并发症中，15例（50%）接受了手术治疗，11例（37%）需要经皮侵入性操作，4例（13%）采取保守治疗。尽管出现了严重并发症，但20例患者中有13例（65%）存活。
对于因急性呼吸衰竭接受ECMO治疗的患者，胸部和腹部CT均具有重要的临床作用，作为床边成像的补充，以排除或显示并发症，并在需要时加快早期侵入性治疗。
