Echocardiography for extracorporeal membrane oxygenation

Abstract

Extracorporeal membrane oxygenation (ECMO) provides advanced cardiopulmonary life support for patients in cardiac and/or respiratory failure. Echocardiography provides essential diagnostic and anatomic information prior to ECMO initiation, allows for safe and efficient ECMO cannula positioning, guides optimization of flow, provides a modality for rapid troubleshooting and patient evaluation, and facilitates decisionmaking for eventual weaning of ECMO support. Currently, guidelines for echocardiographic assessment in this clinical context are lacking. In this review, we provide an overview of echocardiographic considerations for advanced imagers involved in the care of these complex patients. We focus predominately on new cannulas and complex cannulation techniques, including a special focus on double lumen cannulas and a section discussing indirect left ventricular venting. Echocardiography is tremendously valuable in providing optimal care in these challenging clinical situations. It is imperative for imaging physicians to understand the pertinent anatomic considerations, the often complicated physiological and hemodynamic context, and the limitations of the imaging modality.

Veno-venous extracorporeal membrane oxygenation (VV ECMO) cannula malposition identified with point-of-care ultrasound

“…POCUS can also identify clinically relevant cannula site hematomas, peri-cannula thrombus or deep vein thrombosis obstructing circuit flow. Other vascular complications secondary to cannulization including vessel dissection, posterior vessel wall perforation and fistula formation can be identified through POCUS in the hands of an experienced provider [ 8 , 17 ].…”

Visual analysis of the research literature on extracorporeal membrane oxygenation-assisted support for respiratory failure based on CiteSpace and VOSviewer: a 20-year study

“…This capability facilitates the prompt and precise diagnosis and treatment of patients. POCUS can additionally provide clinicians with guidance during invasive procedures, including catheterization and vascular puncture, which significantly enhances the procedure’s precision and safety ( 45 ). In general, these scholarly articles showcased the advancements and refinement of ECMO technology, the investigation and progression of ECMO as a continuous support system for patients with respiratory failure, and the efficacy and safety of ECMO in clinical settings.…”

A Comprehensive Review of Extra Corporeal Membrane Oxygenation: The Lifeline in Critical Moments

“…The findings from echocardiography guide decisions about the need for circulatory support and inform cannulation strategies. In VA-ECMO, precise placement of venous and arterial cannulas is crucial, and echocardiography provides valuable insights to optimize the configuration and efficacy of ECMO support [27].…”