Echocardiography for adult patients supported with extracorporeal membrane oxygenation

Douflé, Ghislaine; Roscoe, Andrew; Billia, Filio; Fan, Eddy

doi:10.1186/s13054-015-1042-2

Cited by 143 publications

(115 citation statements)

References 70 publications

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“…The probe should be positioned before skin preparation. TEE has the advantage of determining the exact position of the cannulae, although the presence of artifacts may be misleading (30). It also allows for prompt diagnosis of any cannulation complications, such as pericardial effusion or cardiac tamponade.…”

Section: Double Vv-ecmo Cannulationmentioning

confidence: 99%

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Veno-venous extracorporeal membrane oxygenation: cannulation techniques

et al. 2016

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The development of extracorporeal membrane oxygenation (ECMO) technology allows a new approach for the intensive care management of acute cardiac and/or respiratory failure in adult patients who are not responsive to conventional treatment. Current ECMO therapies provide a variety of options for the multidisciplinary teams who are involved in the management of these critically ill patients. In this regard, veno-venous ECMO (VV-ECMO) can provide quite complete respiratory support, even if this highly complex technique presents substantial risks, such as bleeding, thromboembolic events and infection.While VV-ECMO circuits usually include the cannulation of two vessels (double cannulation) in its classic configuration, the use of a single cannula is now possible for VV-ECMO support. Recently, experienced centers have employed more advanced approaches by cannulating three vessels (triple cannulation) which follows veno-arterio-venous (VAV) or veno-arterio-pulmonary-arterial cannulation (VAPa). However, 'triple' cannulation expands the field of application but increases the complexity of ECMO systems. In the present review, the authors focus on the indications for VV-ECMO, patient assessment prior to cannulation, the role of ultrasound-guided vessel puncture, double lumen single bicaval cannulations, and finally triple cannulation in VV-ECMO.

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Section: Double Vv-ecmo Cannulationmentioning

confidence: 99%

“…Therefore, a system permitting continuous CO measurement should be used even after ECMO implantation. Echocardiographic and/or pulse contour methods can be used in these patients (30). The DLB cannulae that are currently available offer limited maximal blood flow (45).…”

Section: Double Lumen Single Bicaval Vv-ecmo Cannulationmentioning

confidence: 99%

Veno-venous extracorporeal membrane oxygenation: cannulation techniques

et al. 2016

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“…The guidewire is passed through the needle and transesophageal echocardiography (TEE) confirms its correct position through the right atrium (RA) into the superior vena cava (SVC). In the cath lab, fluoroscopy can be used to visualize the wires but fluoroscopy is not mandatory in VA-ECMO cannulation (20). In some instances, as VA-ECMO implantation during cardiopulmonary resuscitation for refractory cardiac arrest, neither TEE guidance nor fluoroscopy is available.…”

Section: Surgical Cannulation Techniquementioning

confidence: 99%

Veno-arterial extracorporeal membrane oxygenation: an overview of different cannulation techniques

Banfı¹,

Pozzi²,

Brunner³

et al. 2016

J. Thorac. Dis.

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Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has known a widespread application over the last decade and is now an effective and valuable therapeutic option in refractory cardiogenic shock of various etiologies. In this subgroup of critically ill and unstable patients in cardiogenic shock, VA-ECMO allows, on the one hand, temporary hemodynamic stabilization with improvement of endorgan function and, on the other hand, gives the time to perform complementary diagnostic exams and to decide the therapeutic strategy in these high-risk candidates for immediate long-term mechanical circulatory support (MCS) implantation. VA-ECMO could also be suggested as a rescue therapeutic option for refractory cardiac arrest. It showed promising results in the specific setting of in-hospital cardiac arrest and survival rates with good neurological outcome are reported between 20% and 40%. Conversely, there are contrasting data in the literature about survival after VA-ECMO for out-of-hospital cardiac arrest, as results are highly dependent on low-flow time. The aim of the present report is to offer an overview of different cannulation techniques of VA-ECMO.

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“…Several methods are used for the LV decompression during the VA-ECMO therapy: a surgical approach with a minimally invasive thoracotomy, percutaneous approaches via the pulmonary artery or aortic valve, or through a septostomy, percutaneously inserted microaxial pump or intraaortic balloon pump. The LV decompression, during the ECMO therapy, seems to be associated with a significant improvement of the LV function [4]. The left ventricle can be unloaded by an insertion of a pigtail catheter into the LV through the aortic valve and connected to the inflow line of the ECMO circuit by an Y-shaped connector [2].…”

Section: Introductionmentioning

confidence: 99%

Relation Between Left Ventricular Unloading During Ecmo and Drainage Catheter Size Assessed by Mathematical Modeling

2017

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Abstract. The flow-dependent left ventricle overload is a well-known complication of the veno-arterial extracorporeal membrane oxygenation in a severe cardiogenic shock, which leads to a distension of the left ventricle and, frequently, to a severe pulmonary edema. Recently, an unloading of the left ventricle using a catheter inserted to the left ventricle and connected to the extracorporeal membrane oxygenation circuit has been proposed. The computational method was used to simulate the blood flow in the extracorporeal membrane oxygenation system with a drainage catheter incorporated to the left ventricle and connected to the inflow part of the extracorporeal membrane oxygenation circuit by a Y-shaped connector. The whole system was modelled in Modelica modelling language. The impact of various catheter sizes (from 5 Fr to 10 Fr) and extracorporeal blood flow values (from 1 L/min to 5 L/min) were investigated.In our simulation model, the extracorporeal blood flow only modestly affected the value of volume that was withdrawn from the left ventricle by a catheter. Conversely, the size of the drainage catheter was the principal factor responsible for the achievement of the adequate left ventricle decompression. A 10 Fr drainage catheter, inserted into the left ventricle and connected to the venous part of the ECMO system, presents a promising solution to the unloading of the left ventricle during a extracorporeal membrane oxygenation.

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Echocardiography for adult patients supported with extracorporeal membrane oxygenation

Cited by 143 publications

References 70 publications

Veno-venous extracorporeal membrane oxygenation: cannulation techniques

Veno-venous extracorporeal membrane oxygenation: cannulation techniques

Veno-arterial extracorporeal membrane oxygenation: an overview of different cannulation techniques

Relation Between Left Ventricular Unloading During Ecmo and Drainage Catheter Size Assessed by Mathematical Modeling

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