Acute skeletal muscle wasting and relation to physical function in patients requiring extracorporeal membrane oxygenation (ECMO)

Kate Hayes; Anne E Holland; Vincent A Pellegrino; Sunita Mathur; Carol L Hodgson

doi:10.1016/j.jcrc.2018.08.002

Acute skeletal muscle wasting and relation to physical function in patients requiring extracorporeal membrane oxygenation (ECMO)

J Crit Care. 2018 Dec:48:1-8. doi: 10.1016/j.jcrc.2018.08.002. Epub 2018 Aug 7.

Authors

Kate Hayes¹, Anne E Holland², Vincent A Pellegrino³, Sunita Mathur⁴, Carol L Hodgson⁵

Affiliations

¹ Department of Physiotherapy, The Alfred Hospital, Melbourne, Victoria, Australia; Discipline of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia. Electronic address: k.hayes@alfred.org.au.
² Department of Physiotherapy, The Alfred Hospital, Melbourne, Victoria, Australia; Discipline of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia.
³ Intensive Care Department, The Alfred Hospital, Melbourne, Victoria, Australia.
⁴ Department of Physical Therapy, University of Toronto, Toronto, Canada.
⁵ Department of Physiotherapy, The Alfred Hospital, Melbourne, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.

PMID: 30118978
DOI: 10.1016/j.jcrc.2018.08.002

Abstract

Purpose: Muscle weakness is common in patients requiring extracorporeal membrane oxygenation (ECMO), but early identification is challenging. This study aimed to 1) quantify the change in quadriceps size and quality (echogenicity) from baseline to day 10 using ultrasound in patients requiring ECMO, 2) determine the relationship between ultrasound measures, muscle strength and highest mobility level.

Materials and methods: Prospective cohort study involving ultrasound measurement of quadriceps at baseline, days 10 and 20. Muscle strength and highest mobility level were assessed at days 10 and 20 using the Medical Research Council sum-score (MRC), hand-held dynamometry (HHD) and the ICU mobility scale (IMS).

Results: 25 patients (age 49 ± 14 years, 44% male) received ECMO. There was a significant reduction (-19%, p < .001) in rectus femoris cross-sectional area by day 10. Echogenicity did not change over time. There was a negative correlation between echogenicity and MRC at day 10 (r = -0.66) and HHD at day 20 (r = -0.81). At day 20, there was a moderate correlation between total muscle thickness and IMS (rho = 0.59) and MRC (rho = 0.56).

Conclusions: In patients requiring ECMO there was marked wasting of the quadriceps over the first 10 days. Ultrasound measures were related to muscle strength and highest mobility level.

Keywords: Echogenicity; Extracorporeal membrane oxygenation; Intensive care; Intensive care unit acquired weakness; Muscle wasting; Ultrasound.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Critical Illness / rehabilitation*
Extracorporeal Membrane Oxygenation*
Female
Humans
Intensive Care Units
Male
Middle Aged
Muscle Weakness / diagnostic imaging*
Muscle Weakness / physiopathology
Muscle Weakness / rehabilitation
Prospective Studies
Ultrasonography*