Head-to-toe bedside ultrasound for adult patients on extracorporeal membrane oxygenation

Ghislaine Douflé*, Laura Dragoi, Diana Morales Castro, Kei Sato, Dirk W. Donker, Nadia Aissaoui, Eddy Fan, Hannah Schaubroeck, Susanna Price, John F. Fraser, Alain Combes

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Bedside ultrasound represents a well-suited diagnostic and monitoring tool for patients on extracorporeal membrane oxygenation (ECMO) who may be too unstable for transport to other hospital areas for diagnostic tests. The role of ultrasound, however, starts even before ECMO initiation. Every patient considered for ECMO should have a thorough ultrasonographic assessment of cardiac and valvular function, as well as vascular anatomy without delaying ECMO cannulation. The role of pre-ECMO ultrasound is to confirm the indication for ECMO, identify clinical situations for which ECMO is not indicated, rule out contraindications, and inform the choice of ECMO configuration. During ECMO cannulation, the use of vascular and cardiac ultrasound reduces the risk of complications and ensures adequate cannula positioning. Ultrasound remains key for monitoring during ECMO support and troubleshooting ECMO complications. For instance, ultrasound is helpful in the assessment of drainage insufficiency, hemodynamic instability, biventricular function, persistent hypoxemia, and recirculation on venovenous (VV) ECMO. Lung ultrasound can be used to monitor signs of recovery on VV ECMO. Brain ultrasound provides valuable diagnostic and prognostic information on ECMO. Echocardiography is essential in the assessment of readiness for liberation from venoarterial (VA) ECMO. Lastly, post decannulation ultrasound mainly aims at identifying post decannulation thrombosis and vascular complications. This review will cover the role of head-to-toe ultrasound for the management of adult ECMO patients from decision to initiate ECMO to the post decannulation phase.

Original languageEnglish
Pages (from-to)632-645
Number of pages14
JournalIntensive care medicine
Volume50
Issue number5
Early online date10 Apr 2024
DOIs
Publication statusPublished - May 2024

Keywords

  • 2024 OA procedure
  • ECMO
  • Monitoring
  • Ultrasound
  • Echocardiography

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