Diaphragm thickness modifications and associated factors during veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for a cardiogenic shock: a cohort study
Authors' conclusion
In our study, diaphragm thickness evolution was frequent and not associated with the diaphragm thickening fraction.
Study context
- Population
- Patients on VA-ECMO for cardiogenic shock, 12-bed ICU in France
- Participants
- 29 patients
- Exposure
- Atrophy vs Stable vs Increase
- Atrophyn = 7
- Stablen = 18reference
- Increasen = 4
- Outcome
- Changes in diaphragm thickness (ultrasound, daily; mixed-effect linear model)
- Follow-up
- First week of VA-ECMO
Methodological detailssingle-centre, observational
- Single-centre
- Observational
Main finding
As reported in the abstract
Diaphragm thickness evolution by day 7
- Diaphragm thickness changes associated with sweep gas flow (Beta, mixed-effect linear model)
- - 3; 95% CI [- 4.8; - 1.2]; p-value = 0.001
- Diaphragm thickness changes associated with pH (Beta, mixed-effect linear model)
- - 2; CI [- 2.9; - 1]; p-value < 0.001
- Diaphragm thickness changes not associated with dTF
- P = 0.13
Observational data: associations, not effects.
Further findings
Death at 60 days with diaphragm atrophy by day 7
| OR (CI) | P value | ||
|---|---|---|---|
| Diaphragm atrophy | 8.50 (1.4–74) | P = 0.029 | |
| 0.050.21520Odds ratio (log scale) |
| Outcome | Early-extubated | Extubated later | Beta (95% CI) | P value |
|---|---|---|---|---|
| Diaphragm atrophy by extubation timing (early extubation < day4) | 0 events | 46% | P = 0.008 | |
| Low dTF (< 20%) at study end and association with sweep gas flow evolution (MLM) | - 2.8 (- 5.2; - 0.5) | P = 0.017 |
- Low dTF (< 20%) at study end and association with sweep gas flow evolution (MLM) — dTF remained low (< 20%)
- 20 patients (69%)
- Diaphragm atrophy by extubation timing (early extubation < day4): 13 early-extubated patients
Original publication
Diaphragm thickness modifications and associated factors during VA-ECMO for a cardiogenic shock: a cohort study. Ann Intensive Care. Published 8 March 2024. doi:10.
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