Critical Illness Clinical Trial
Official title:
Acute Skeletal Muscle Wasting and Relation to Physical Function in Patients Requiring Extracorporeal Membrane Oxygenation (ECMO)
The purpose of this study is to describe the changes in quadriceps muscle size and quality over the first 10 days on extracorporeal membrane oxygenation (ECMO) using ultrasound imaging. This study will also examine the relationship between those changes and muscle strength and level of physical function at day 10 and day 20 after ECMO commencement.
The use of ECMO has increased dramatically in the past decade with improvements in technology
and survival. Whilst it is a potentially life-saving intervention in a group of patients at
high risk of death, it is both highly invasive and expensive. ECMO poses a dramatic
physiological burden on patients with major long-term consequences. Among these, severe
prolonged neuromuscular weakness is perhaps the most significant complication. Described
clinically as intensive care unit acquired weakness (ICUAW), it is associated with prolonged
weaning from mechanical ventilation, delayed rehabilitation, increased hospital length of
stay, and mortality with residual deficits in physical functional ability persisting up to 5
years following the ICU admission. The health value, to both patients and society, could be
substantially improved if more patients achieved a complete recovery.
Muscle strength testing in the early stages of critical illness is limited, as it requires
the patient to be awake, alert and cognitively intact, therefore delayed diagnosis of ICUAW
due to inability of patients to complete muscle strength testing is common. Consequently,
there is growing interest in the utility of ultrasound imaging to monitor the trajectory of
muscle wasting and inform development of targeted interventions in these critically ill
patients. Ultrasound imaging of skeletal muscle is a non-invasive, painless and radiation
free technique that can provide objective, accurate and reliable data on skeletal muscle in
these critically ill patients. This study will use ultrasound imaging to quantify the early
change in skeletal muscle size and quality, and the relationship to strength and physical
function in patients on ECMO. Risk stratification of patients with peripheral muscle wasting
is vital for optimising clinical management, including development of improved rehabilitative
strategies to improve recovery and optimise the risk/benefit profile of ECMO.
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