Prognostic impact of lung computed tomography density in cardiogenic shock patients with veno-arterial extracorporeal membrane oxygenation

Background: Pulmonary complications often occur in patients receiving venoarterial extracorporeal membrane oxygenation (VA ECMO). However, the prognostic impact of lung damage has not been fully elucidated.Methods: This single-center retrospective observational study targeted patients with cardiogenic shock who received VA ECMO between 2012 and 2021. This study included 65 patients who underwent chest computed tomography (CT) on VA ECMO, followed by escalation to central mechanical circulatory support (MCS) with left ventricular venting. The average density of lung CT images was measured using region - of-interest methods, and the primary endpoint was 180 -day all- cause death after escalation to the central MCS.Results: Twenty- two patients (34%) developed 180 -day all- cause death. According to the Cox regression analysis, age (hazard ratio [HR], 1.08; 95% confidence interval [CI], 1.03- 1.14; p = 0.001), ischemic etiology (HR, 5.53; 95% CI, 2.09- 14.62; p < 0.001), duration of VA ECMO support (HR, 1.19; 95% CI, 1.00- 1.40; p = 0.045), and lung CT density (= -481 Hounsfield unit [HU]) (HR, 6.33; 95% CI, 2.26- 17.72; p < 0.001) were independently associated with all- cause death. Receiver operating characteristic curve analysis determined that lung CT density = -481 HU is an optimal cutoff value for predicting all- cause death (area under the curve [AUC], 0.72). The 180 -day overall survival rate for patients with high lung CT density (= -481 HU) was significantly lower than that for those with low lung CT density (< -481 HU) (44.4% vs. 81.6%, respectively, p = 0.002).Conclusions: Higher lung CT density could be a useful predictor of death in patients with VA ECMO requiring central MCS escalation.