Pilot study investigating how Extracorporeal Membrane Oxygenation (ECMO) affects the major breathing muscles.

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The diaphragm; the major breathing muscle, as a result of life supporting mechanical ventilation reduces in size, thickness and function (Umbrello, 2016). Diaphragm atrophy and dysfunction as a result of mechanical ventilation can lead to critically ill patients having a higher intensive care unit (ICU) mortality rate, increased ICU length of stay (LOS), increased mechanical ventilation duration and a higher rate of re-intubation (Demoule et al, 2013;). There is currently no body of evidence regarding the onset or extent of diaphragm atrophy in patients who receive Extracorporeal Membrane Oxygenation (ECMO) therapy; a patient cohort predisposed to atrophy and dysfunction of the diaphragm due to very low lung volumes delivered by the breathing machine, deep sedation and immobility. By using diagnostic ultrasound (US) in this study, we can accurately assess diaphragm thickness and determine the onset and rate of diaphragm atrophy in the ECMO cohort Aims: This pilot study aims to investigate if diaphragm atrophy occurs and the rate of diaphragm atrophy incurred whilst a patient is receiving ECMO therapy. The research questions are: 1. Does ECMO therapy lead to diaphragm atrophy as measured by diaphragm thickness on ultrasound? 2. What is the rate of diaphragm atrophy for patients receiving ECMO therapy? 3. Is there a difference in the rate of diaphragm atrophy between patients on VV versus patients on VA ECMO? Design: As this is a pilot study, we will recruit all patients that receive ECMO therapy after consent is obtained from the patient’s next of kin. Ultrasound data and other measurements will be collected at the onset of ECMO insertion and every second day until ECMO decannulation to identify the onset and rate of diaphragm atrophy.

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