Journal of Acute Care

Register      Login

VOLUME 2 , ISSUE 3 ( September-December, 2023 ) > List of Articles


The Role of Echocardiography in Extracorporeal Membrane Oxygenation

Sunil Kumar V, Sanjay Orathi Patangi

Keywords : Atherosclerotic, Cannula, Catheterization, Extracorporeal membrane oxygenation, Humans, Plaque, Stroke volume, Thrombosis, Vascular diseases, Vena cava

Citation Information : V S K, Patangi SO. The Role of Echocardiography in Extracorporeal Membrane Oxygenation. 2023; 2 (3):153-157.

DOI: 10.5005/jp-journals-10089-0090

License: CC BY-NC 4.0

Published Online: 19-02-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Echocardiography (ECHO) is an essential diagnostic tool for patients who require extracorporeal membrane oxygenation (ECMO). ECMO provides oxygenation and circulatory support to patients with severe cardiac/respiratory dysfunction. ECHO plays an important role in the management and evaluation of ECMO therapy. ECHO is a relatively noninvasive imaging technique that uses high-frequency sound waves to produce detailed imaging of the heart's structure and functionality. It is used to evaluate various aspects of cardiac function, including cardiac output, ejection fraction (EF), regional wall motion abnormalities (RWMA), and valvular function. ECHO provides vital information about the cardiopulmonary physiological response to ECMO therapy. Apart from helping identify intra and extracardiac thrombi and clots, it is used for the assessment of ECMO cannula placement to optimize blood flow mechanics and gas exchange. One of the advantages of ECHO in ECMO support is its versatility in providing real-time feedback that enables clinicians to optimize therapy and mitigate potential complications during the ECMO run. ECHO helps diagnose and quantify conditions that cause hemodynamic instability, such as undiagnosed valvular lesions, ventricular dysfunction, and aortic dissection. Epiaortic ECHO provides information about aortic atheroma and aids in selecting the best site for aortic cannulation. The placement of venous cannula for venovenous (VV)—ECMO or venoarterial (VA)—ECMO can be affected by anatomical abnormalities of the heart such as left-sided superior vena cava (SVC), Chiari network, prominent eustachian valve, atrial septal defect (ASD) all of which can be diagnosed by ECHO.

  1. Lorusso R, Shekar K, MacLaren G, et al. ELSO interim guidelines for venoarterial extracorporeal membrane oxygenation in adult cardiac patients. ASAIO J 2021;67(8):827–844. DOI: 10.1097/MAT.0000000000001510
  2. Sedgwick JF, Burstow DJ, Platts DG. ECMO and ECHO: the role of echocardiography in the management of patients supported by extracorporeal membranous oxygenation (ECMO). Int J Cardiol 2011;147(Suppl):S16–S17. DOI: 10.1016/j.echo.2011.11.009
  3. Firstenberg MS, Orsinelli DA. ECMO and ECHO: the evolving role of quantitative echo in the management of patients requiring extracorporeal membrane oxygenation. J Am Soc Echocardiogr 2012;25(6):641–643. DOI: 10.1016/j.echo.2012.04.005
  4. Platts DG, Sedgwick JF, Burstow DJ, et al. The role of echo in the management of patients supported by extracorporeal membrane oxygenation. J Am Soc Echocardiogr 2012;25(2):131–141. DOI: 10.1016/j.echo.2011.11.009
  5. Ficial B, Vasques F, Zhang J, et al. Physiological basis of extracorporeal membrane oxygenation and extracorporeal carbon dioxide removal in respiratory failure. Membranes(Basel) 2021;11(3):225. DOI: 10.3390/membranes11030225
  6. Giraud R, Banfi C, Bendjelid K. Echocardiography should be mandatory in ECMO venous cannula placement. Eur Heart J Cardiovasc Imaging 2018;19(12):1429–1430. DOI: 10.1093/ehjci/jey142
  7. Douflé G, Roscoe A, Billia F, et al. Echocardiography for adult patients supported with extracorporeal membrane oxygenation. Crit Care 2015;19:326. DOI: 10.1186/s13054-015-1042-2
  8. Tritapepe L. ECMO management guided by echo: is it feasible? Minerva Anestesiol 2016;82(10):1023–1025.
  9. Donker DW, Meuwese CL, Braithwaite SA, et al. Echocardiography in extracorporeal life support: a key player in procedural guidance, tailoring and monitoring. Perfusion 2018;33(1_suppl):31–41. DOI: 10.1177/0267659118766438
  10. Guinot PG, Soulignac C, Zogheib E, et al. Interactions between venovenous extracorporeal membrane oxygenation and cardiac function. An echocardiographic study upon weaning. Br J Anaesth 2016;117(6):821–822. DOI: 10.1093/bja/aew365
  11. Tonna JE, Abrams D, Brodie D, et al. Management of adult patients supported with venovenous extracorporeal membrane oxygenation (VV ECMO): Guideline from the extracorporeal life support organization (ELSO). ASAIO J 2021;67(6):601–610. DOI: 10.1097/MAT.0000000000001432
  12. Sidebotham D, McGeorge A, McGuinness S, et al. Extracorporeal membrane oxygenation for treating severe cardiac and respiratory failure in adults: part 2–technical considerations. J Cardiothorac Vasc Anesth 2010;24(1):164–172. DOI: 10.1053/j.jvca.2009.08.002
  13. Patel B, Arcaro M, Chatterjee S. Bedside troubleshooting during venovenous extracorporeal membrane oxygenation (ECMO). J Thorac Dis 2019;11(Suppl 14):S1698–S1707. DOI: 10.21037/jtd.2019.04.81
  14. Javidfar J, Wang D, Zwischenberger JB, et al. Insertion of bicaval dual lumen extracorporeal membrane oxygenation catheter with image guidance. ASAIO J 2011;57(3):203–205. DOI: 10.1097/MAT.0b013e3182155fee
  15. Griffee MJ, Zimmerman JM, McKellar SH, et al. Echocardiography-guided dual-lumen venovenous extracorporeal membrane oxygenation cannula placement in the ICU- retrospective review. J Cardiothorac Vasc Anesth 2020;34(3):698–705. DOI: 10.1053/j.jvca.2019.10.024
  16. Pavlushkov E, Berman M, Valchanov K. Cannulation techniques for extracorporeal life support. Ann Transl Med 2017;5(4):70. DOI: 10.21037/atm.2016.11.47
  17. Kowalewski M, Malvindi PG, Zielinski K, et al. Left ventricle unloading with veno-arterial extracorporeal membrane oxygenation for cardiogenic shock. systematic review and meta-analysis. J Clin Med 2020;9(4):1039. DOI: 10.3390/jcm9041039
  18. Wong ASK, Sin SWC. Short-term mechanical circulatory support (intra-aortic balloon pump, Impella, extracorporeal membrane oxygenation, TandemHeart): a review. Ann Transl Med 2020;8(13):829. DOI: 10.21037/atm-20-2171
  19. Hussey PT, von Mering G, Nanda NC, et al. Echocardiography for extracorporeal membrane oxygenation. Echocardiography 2022;39(2):339–370. DOI: 10.1111/echo.15266
  20. Chimot L, Marqué S, Gros A, et al. Avalon© bicaval dual-lumen cannula for venovenous extracorporeal membrane oxygenation: survey of cannula use in France. ASAIO J 2013;59(2):157–161. DOI: 10.1097/MAT.0b013e31827db6f3
  21. Maybauer MO, Koerner MM, Mihu MR, et al. The ProtekDuo as double lumen return cannula in V-VP ECMO configuration: a first-in-man method description. Ann Card Anaesth 2022;25(2):217–219. DOI: 10.4103/aca.aca_49_21
  22. Ricarte Bratti JP, Cavayas YA, Noly PE, et al. Modalities of left ventricle decompression during VA-ECMO therapy. Membranes (Basel) 2021;11(3):209. DOI: 10.3390/membranes11030209
  23. Aissaoui N, Guerot E, Combes A, et al. Two-dimensional strain rate and Doppler tissue myocardial velocities: analysis by echocardiography of hemodynamic and functional changes of the failed left ventricle during different degrees of extracorporeal life support. J Am Soc Echocardiogr 2012;25(6):632–640. DOI: 10.1016/j.echo.2012.02.009
  24. Kim D, Jang WJ, Park TK, et al. Echocardiographic predictors of successful extracorporeal membrane oxygenation weaning after refractory cardiogenic shock. J Am Soc Echocardiogr 2021;34(4):414–422e4. DOI: 10.1016/j.echo.2020.12.002
  25. Marasco SF, Lukas G, McDonald M, et al. Review of ECMO (extra corporeal membrane oxygenation) support in critically ill adult patients. Heart Lung Circ 2008;17(Suppl 4):S41–S47. DOI: 10.1016/j.hlc.2008.08.009
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.