Thoracic complications of extracorporeal membrane oxygenation: findings on chest radiographs and sonograms.

Abstract

This study is based on a review of the medical records and findings on chest radiographs and sonograms of 150 neonates who were treated with ECMO at our institution.

Venous thrombosis in and after extracorporeal membrane oxygenation: detection and follow-up by color Doppler sonography

“…Sonography has proved to be an adequate tool for monitoring babies and infants on and after ECMO [5,6,11,13,14,16]. The arterial access using the rCCA has been suspected to result in a higher incidence of right-sided brain lesions during ECMO [17].…”

The Role of Imaging During Extracorporeal Membrane Oxygenation in Pediatric Respiratory Failure

“…Sonography aids in the evaluation of pleural collections (Fig. 12) and may show hemorrhage, which appears echogenic and complex [27,28]. Although the lungs remain opacified, significant mediastinal shift due to pleural collections or lung collapse can be detected only by the displacement of the support lines and tubing [29] (Fig.…”

MRI of the Brain and Thorax during Extracorporeal Membrane Oxygenation: Preliminary Report from a Pig Model

“…The initial radiograph is useful in confirming that the positions of the ECMO cannulae are appropriate to ensure sufficient flow rates and to help reduce possible complications. The tip of the venous draining cannula is generally in the right atrium, and the tip of the arterial returning cannula (in VA ECMO) projects over the aortic arch at the origin of the innominate artery (50,54) (Fig 3). When patients are initially placed on ECMO, lung opacity typically increases, the chest radiograph "goes from bad to terrible" (Fig 4a).…”

“…Routine daily chest radiographs in periods of clinical stability has not been found helpful in providing additional information during the ECMO run (52,53). However during periods of worsening of the clinical status, chest examinations can often assist in diagnosing the cause, such as malposition and migration of various tubes and catheters, air collections or rapidly enlarging pleural effusion (53,54). A rapidly increasing pleural effusion in a patient receiving ECMO is indicative of hemothorax, due to anticoagulant therapy and ECMO induced coagulopathy (50).…”

“…Furthermore cranial US is of no use in adults and children, after the closing of the fontanels. Thoracic complications of ECMO include malposition of various tubes and catheters, abnormal air collections, pleural and pericardial effusions and hemorrhages as well as pulmonary hemorrhage (54). Portable chest radiographs can correctly identify many of these complications.…”