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Relationship between skeletal muscle area and density and clinical outcome in adults receiving veno-venous extracorporeal membrane oxygenation

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Danielle E. Bear, Liisa MacGowan, Maria Elstad, Zudin A Puthucheary, Bronwen Connolly, Rebeka Wright , Nicholas Hart, Stephen Harridge, Kevin Whelan, Nicholas A Barrett, Luigi Camporota

Original languageEnglish
JournalCritical Care Medicine
Accepted/In press16 Nov 2020

King's Authors

Abstract

Objective
To investigate the prevalence of low skeletal muscle index (area normalised for height) and density, their trajectory of change and to determine associations with clinical outcome in adults with severe respiratory failure requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO).
Design
Prospective observational study.
Patients
Adults receiving VV-ECMO for a minimum of 72 hours and a maximum of 6-months between September 2010 – June 2017, who had a computed tomography (CT) scan which included the third lumbar vertebra (L3).
Intervention
None
Measurements and main results
Skeletal muscle index and density was determined using Slice-O-Matic V5.0 (TomoVision, Montreal, Canada). Low skeletal muscle index and density were defined using published criteria. Regression models were used to assess for associations between muscle index and density and clinical outcome. 215 patients, median (IQR) age 46 (35.0-57.0) years were included. Forty-five (21.1%) patients had low skeletal muscle index and 48 (22.3%) had low skeletal muscle density on commencement of VV-ECMO. Low skeletal muscle index was more prevalent in males (28.8% vs. 11.6%, X2=9.4, p = .002) and was associated with a longer duration of VV-ECMO (B 5.0, 95% CI 0.2-9.9, p = .042). Higher skeletal muscle density was independently associated with ICU survival (OR 1.6 per 10 Hounsfield Units, 95% CI 1.1-2.5, p = .025). No relationship was observed between skeletal muscle index nor density and physical function. Adequacy of energy and protein did not influence change in skeletal muscle index or density.
Conclusions
Low skeletal muscle index at the commencement of VV-ECMO was associated with a longer duration of VV-ECMO, whereas preserved skeletal muscle density was associated with improved survival.
Keywords (4-6)
Critical illness, muscle mass, muscle quality, ECMO, nutrition, physical function

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