Relationship between skeletal muscle area and density and clinical outcome in adults receiving venovenous extracorporeal membrane oxygenation

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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)


OBJECTIVES: To investigate the prevalence of low skeletal muscle index (area normalized for height) and density, their trajectory of change, and to determine associations with clinical outcome in adults with severe respiratory failure requiring venovenous extracorporeal membrane oxygenation. DESIGN: Prospective observational study. PATIENTS: Adults receiving venovenous extracorporeal membrane oxygenation for a minimum of 72 hours and a maximum of 6 months between September 2010 and June 2017, who had a CT scan which included the third lumbar vertebra. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Skeletal muscle index and density was determined using Slice-O-Matic V5.0 (TomoVision, Montreal, QC, 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. Two-hundred fifteen patients, median (interquartile range) age 46 years (35.0-57.0 yr) were included. Forty-five patients (21.1%) had low skeletal muscle index, and 48 (22.3%) had low skeletal muscle density on commencement of venovenous extracorporeal membrane oxygenation. Low skeletal muscle index was more prevalent in males (28.8% vs 11.6%; χ2= 9.4; p = 0.002) and was associated with a longer duration of venovenous extracorporeal membrane oxygenation (B = 5.0; 95% CI, 0.2-9.9; p = 0.042). Higher skeletal muscle density was independently associated with ICU survival (odds ratio 1.6 per 10 Hounsfield units; 95% CI, 1.1-2.5; p = 0.025). 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 venovenous extracorporeal membrane oxygenation was associated with a longer duration of venovenous extracorporeal membrane oxygenation, whereas preserved skeletal muscle density was associated with improved survival.

Original languageEnglish
Pages (from-to)E350-E359
JournalCritical care medicine
Issue number4
Publication statusPublished - 01 Apr 2021

Bibliographical note

Funding Information:
Drs. Barrett and Camporota contributed equally. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website ( Dr. Bear’s institution received funding from the National Institute of Health Research (NIHR) and Health Education England ICA Clinical Doctoral Research Fellowship (ICA-CDRF-2015-01-047), and she reports receiving advisory board fees, speaker fees, or conference attendance support from Nutricia, Nestle Nutrition, BBraun, Baxter healthcare, Fresenius Kabi, Abbott Nutrition Cardinal Health, and Avanos.

Funding Information:
Drs. Bear and Elstad received support for article research from NIHR. Dr. Puthucheary received funding from Faraday Pharmaceuticals, Fresenius Kabi, Lyric Pharmaceuticals, Nestle, Orion, and GlaxoSmithKline. This article presents independent research funded by the NIHR and Health Education England. Dr. Connolly’s institution received funding from an NIHR Postdoctoral Fellowship (PDF-2015-08-015). Dr. Hart received funding from Philips and Resmed with the funds held and managed by Guy’s & St Thomas’ NHS Foundation Trust; he received financial support from Philips for development of the MYOTRACE technology that has patent approved in Europe (U.S. pending) outside the area of work commented on here; and he received personal fees from Philips-Respironics, Philips, Resmed, and Fisher-Paykel. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.


  • critical illness
  • extracorporeal membrane oxygenation
  • muscle mass
  • muscle quality
  • nutrition
  • physical function

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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