extracorporeal membrane oxygenation

Newborn who
did not receive a screening head ultrasound before being placed emergently on ECMO and who is not doing well on ECMOCoronal and sagittal US of the brain shows a high flow vascular structure in the region of the median prosencephalic vein. A bruit was subsequently noted in this area.The diagnosis was Vein of Galen malformation, which is a contraindication to being placed on ECMO.
pediatricimaging.org • CC-by-nc-sa 4.0
Newborn with
a left congenital diaphragmatic hernia on arterial-venous (AV) ECMOCXR shows normal position of the arterial catheter tip in the aortic arch and normal position of the venous catheter tip in the right atrium, both of which are shifted to the right by the diaphragmatic hernia. Note that the endotracheal tube, which is positioned between the two ECMO catheters, is also shifted to the right.The diagnosis was normal position of the AV ECMO catheter tips in a neonate.
pediatricimaging.org • CC-by-nc-sa 4.0
Infant with
viral pneumonia on venous-venous (VV)ECMOCXR shows normal position of the venous catheter tip near the junction of the right atrium and the inferior vena cava.The diagnosis was normal position of the VV ECMO catheter tip in an infant.
pediatricimaging.org • CC-by-nc-sa 4.0
Newborn with
persistent pulmonary hypertension on ECMO with blood coming out of right chest tubeSagittal and transverse US of the right chest shows a complex fluid collection in the right pleural space.The diagnosis was hemothorax as a complication of ECMO.
pediatricimaging.org • CC-by-nc-sa 4.0
Newborn who
is on ECMO after cardiac surgeryCoronal US of the brain (below) shows echogenic material in right subdural space. Coronal and sagittal US of the brain (above) shows a right parietal round mixed echogenicity lesion.The diagnosis was subdural hematoma on ECMO and intracerebral hemorrhage on ECMO.
pediatricimaging.org • CC-by-nc-sa 4.0
Newborn with
congenital diaphragmatic hernia on ECMOCoronal and sagittal US of the brain shows a large, round echogenic lesion in the left parietal lobe.The diagnosis was intracerebral hemorrhage on ECMO.
pediatricimaging.org • CC-by-nc-sa 4.0
Infant after
cardiac surgery on ECMOAxial and coronal CT without contrast of the brain shows three round mixed density lesions in the cerebellum compressing the fourth ventricle and causing hydrocephalus. The fluid-fluid levels in the lesions were felt to represent active bleeding.The diagnosis was cerebellar hemorrhage on ECMO.
pediatricimaging.org • CC-by-nc-sa 4.0
Preschooler
on ECMO after cardiac surgery with a tube in the esophagusCXR AP shows an open chest with an ECMO arterial catheter tip in the aortic arch and an ECMO venous catheter tip in the right atrium. A wide-diameter tube with a sensor at the end projects over the esophagus which represents a transesophageal echocardiogram probe. The diagnosis was a patient on extracorporeal membrane oxygenation with a mimic of a nasogastric tube.
pediatricimaging.org • CC-by-nc-sa 4.0
Extracorporeal
membrane oxygenation • Extracorporeal membrane oxygenation device - Ganzer Fall bei Radiopaedia
Salam H, Extracorporeal membrane oxygenation device. Case study, Radiopaedia.org (Accessed on 08 Dec 2022) https://doi.org/10.53347/rID-9795 • CC by-nc-sa 3.0 (modified)
Extracorporeal
membrane oxygenation • VV ECMO in acute respiratory failure - Ganzer Fall bei Radiopaedia
Shah V, VV ECMO in acute respiratory failure. Case study, Radiopaedia.org (Accessed on 08 Dec 2022) https://doi.org/10.53347/rID-64710 • CC by-nc-sa 3.0 (modified)
Toddler with
respiratory distress. CXR AP (above) shows the arterial catheter tip projecting over the aortic arch and the venous catheter tip projecting over the right atrium. There is bilateral diffuse airspace disease and bilateral pleural effusions. A cystic lesion is seen in the right lower lobe. Axial CT without contrast of the chest (below left) shows the cystic lesion is thin walled and communicates with the bronchial tree and has multiple septations (below right).The diagnosis was pneumatocele due to pneumococcal pneumonia in a patient on ECMO.
pediatricimaging.org • CC-by-nc-sa 4.0
Newborn with
a left-sided chest mass on prenatal ultrasound. CXR AP shows complete opacification of the left hemithorax with mediastinal shift to the right and a small right pneumothorax. The arterial ECMO canula tip projects over the aortic arch and the venous ECMO canula tip projects over the right atrium. The nasogastric tube tip projects over the mid-esophagus.The diagnosis was left congenital diaphragmatic hernia in a patient on extracorporeal membrane oxygenation.
pediatricimaging.org • CC-by-nc-sa 4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Extracorporeal membrane oxygenation (ECMO) is used as a modified pulmonary or cardiopulmonary bypass technique in those with severe cardiac and/or respiratory failure refractory to conventional ventilatory support and medical intervention . There are two access paths for extracorporeal life support (ECLS) cannulation, venoarterial (VA) ECMO and venovenous (VV) ECMO, which can be performed via a surgical cut-down or percutaneous insertion.

Terminology

The basic components of an ECMO circuit are as follows:

  • cannulae
    • traditionally, two cannulae were introduced for blood drainage and return, respectively
    • drainage cannulae are typical of a larger bore (23–31 F) compared to return cannulae (15–19 F) 
      • exact diameter dependent on numerous factors, including target vessel and approach
  • membrane oxygenator/heat exchanger
  • blood pump
    • roller pumps
    • centrifugal pumps
  • conduit tubing

Venoarterial (VA) ECMO

The ECLS system, as VA ECMO, drains the blood from the right atrium via a femoral or internal jugular venous cannula or in patients with an open chest, directly from the right atrium. The blood is actively pumped through a membrane oxygenator, removing carbon dioxide and adding oxygen. Afterwards, the oxygenated blood is actively pumped into the arterial central system via a cannula placed in the femoral or subclavian artery (closed chest) or directly into the aorta. VA ECLS can provide full cardiopulmonary support with a high blood flow up to 6-7 L/min.

Venovenous (VV) ECMO

VV ECMO drains blood from the superior vena cava via an internal jugular venous cannula or inferior vena cava via a femoral venous cannula. The blood is pumped via the oxygenator back into the venous system via a femoral venous cannula. A double-lumen cannula, inserted in the internal jugular vein, can be used for venous drainage and return. VV ECMO can provide full or partial extracorporeal pulmonary support with blood flow up to 6 L/min.

Radiographic findings

Transesophageal echocardiography

TEE has been used to guide placement of venovenous ECMO cannulation. It is most commonly employed for the placement of a bicaval double-lumen cannula, usually introduced percutaneously in the right internal jugular vein. This single cannula has ports allowing simultaneous drainage of deoxygenated blood from the IVC and SVC, with a return lumen that should be angulated so that flow travels through the tricuspid valve into the right ventricle .

  • mid-esophageal bicaval view
    • using the Seldinger technique, a wire is advanced from the right internal jugular vein toward the inferior vena cava
    • the bicaval view allows visualization of the wire as it courses from the SVC to the IVC across the right atrium in the sonographic far field, thus excluding accidental intraventricular misplacement
      • inadvertent placement of the guidewire in the right ventricle may result in complications such as;
  • modified transgastric position
    • probe may be advanced to visualize the wire tip terminating in the IVC below the hepatic veins
  • modified midesophageal bicaval view
    • once the catheter has been advanced, the probe may be withdrawn and color flow Doppler interrogation of the side port of the ECMO cannula may be used to assess the appropriateness of the return port orientation
    • correct placement is suggested by an aliased color jet coursing toward the tricuspid valve originating from a catheter placed in the right atrium
Transesophageal echocardiography

Contrast-enhanced CT examinations of patients undergoing ECMO presents unique technical and diagnostic challenges. A number of considerations can be explored here.

Complications

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Extrakorporale Membranoxygenierung:
Pleuraerguss
 
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Lungenblutung
 
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