P0385 / #744: THE VALUE OF INSPIRATORY AND EXPIRATORY CHEST CT TO GUIDE VENTILATORY STRATEGY FOR CHILDREN REQUIRING RESPIRATORY ECMO SUPPORT

Abstract

Aims & Objectives: To describe a single institution experience on inspiratory and expiratory computed tomography (CT) to determine lung recruitability in children requiring respiratory extracorporeal membrane oxygenation (ECMO) support. Methods: Retrospective review of 5 cases referred for respiratory ECMO to tertiary children’s ICU from 2018 to 2019. All patients had oxygen saturation <80% despite maximal conventional ventilation (Peak pressure >35) or high frequency oscillation. A chest CT was performed in all cases either before or on ECMO to define ventilatory strategy. The CT was used to determine how much lung was recruitable between expiration (pressure 0 to 5 cmH20) and maximum inspiration (pressure 45 cmH20). Results: Five patients (median weight 8 kg, range 3 – 23) and age (median 4.0 years, range 0.1 to 12.0 years) developed severe hypoxic hypercarbic respiratory failure requiring ECMO. The Table 1 shows the summary of the CT chest findings and their clinical outcomes.FIGURE 1FIGURE 2Patients with non-recruitable lungs either died (Case 1) or had a prolonged ECMO run of six weeks. (Case 2, Figure 2). When lung was recuritable, we used an aggressive physiotherapy and bronchoscopy regime and promoted ventilation rather than lung resting strategy(Figure 1). Case 3 required selective intubation of the right lung. Conclusions: CT chest with inspiratory and expiratory views provide useful information in severe ARDS to help define ventilation strategy, especially on ECMO. Lack of lung recruitability on CT suggests a prolonged or futile ECMO course. Further studies are warranted