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Echocardiography for adult patients supported with extracorporeal membrane oxygenation.

Douflé G, Roscoe A, Billia F, Fan E - Crit Care (2015)

Bottom Line: Venoarterial (VA) and venovenous (VV) extracorporeal membrane oxygenation (ECMO) support is increasingly being used in recent years in the adult population.Owing to the underlying disease precipitating severe respiratory or cardiac failure, echocardiography plays an important role in the management of these patients.Nevertheless, there are currently no guidelines on the use of echocardiography in the setting of ECMO support.

View Article: PubMed Central - PubMed

Affiliation: Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, M5G 2N2, Canada. ghislaine.doufle@uhn.ca.

ABSTRACT
Venoarterial (VA) and venovenous (VV) extracorporeal membrane oxygenation (ECMO) support is increasingly being used in recent years in the adult population. Owing to the underlying disease precipitating severe respiratory or cardiac failure, echocardiography plays an important role in the management of these patients. Nevertheless, there are currently no guidelines on the use of echocardiography in the setting of ECMO support. This review describes the current state of application of echocardiography for patients supported with both VA and VV ECMO.

No MeSH data available.


Related in: MedlinePlus

Venovenous (VV) and venoarterial (VA) extracorporeal membrane oxygenation (ECMO) configurations and corresponding echocardiographic views. This diagram shows the most common ECMO configurations in our center. (1) Bicannulation VV ECMO (femoro-jugular cannulation) with the drainage cannula in the femoral vein and the reinjection in the superior vena cava (SVC), via the jugular vein. a Mid-esophageal view showing the SVC and reinjection cannula within it (transesophageal echocardiography). b Inferior vena cava (IVC) subcostal view. The drainage cannula is visualized within the IVC in long axis (transthoracic echocardiography). (2) Femoro-femoral VA ECMO cannulation. The drainage cannula is located in the IVC and the reinjection cannula is in the iliac artery/distal descending aorta. c Transthoracic apical four-chamber of a patient with a dilated cardiomyopathy. The cannulae are not visualized on this view but note the presence of an automatic implantable cardioverter defibrillator within the right ventricle
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Fig1: Venovenous (VV) and venoarterial (VA) extracorporeal membrane oxygenation (ECMO) configurations and corresponding echocardiographic views. This diagram shows the most common ECMO configurations in our center. (1) Bicannulation VV ECMO (femoro-jugular cannulation) with the drainage cannula in the femoral vein and the reinjection in the superior vena cava (SVC), via the jugular vein. a Mid-esophageal view showing the SVC and reinjection cannula within it (transesophageal echocardiography). b Inferior vena cava (IVC) subcostal view. The drainage cannula is visualized within the IVC in long axis (transthoracic echocardiography). (2) Femoro-femoral VA ECMO cannulation. The drainage cannula is located in the IVC and the reinjection cannula is in the iliac artery/distal descending aorta. c Transthoracic apical four-chamber of a patient with a dilated cardiomyopathy. The cannulae are not visualized on this view but note the presence of an automatic implantable cardioverter defibrillator within the right ventricle

Mentions: The two main configurations of ECMO currently used are VV ECMO, for respiratory support, and venoarterial (VA) ECMO, for cardiorespiratory support (Fig. 1). VV ECMO does not directly provide cardiac support; however, resolution of severe hypoxemia and hypercapnia will decrease the pulmonary vascular resistance, reducing the right ventricle (RV) afterload and improving RV function [12]. This should augment left ventricle (LV) filling. In addition, the institution of VV ECMO usually results in reduction of airway pressures, which also decreases RV afterload. In patients with cardiorespiratory compromise, VA ECMO is the modality of choice and provides full cardiopulmonary support.Fig. 1


Echocardiography for adult patients supported with extracorporeal membrane oxygenation.

Douflé G, Roscoe A, Billia F, Fan E - Crit Care (2015)

Venovenous (VV) and venoarterial (VA) extracorporeal membrane oxygenation (ECMO) configurations and corresponding echocardiographic views. This diagram shows the most common ECMO configurations in our center. (1) Bicannulation VV ECMO (femoro-jugular cannulation) with the drainage cannula in the femoral vein and the reinjection in the superior vena cava (SVC), via the jugular vein. a Mid-esophageal view showing the SVC and reinjection cannula within it (transesophageal echocardiography). b Inferior vena cava (IVC) subcostal view. The drainage cannula is visualized within the IVC in long axis (transthoracic echocardiography). (2) Femoro-femoral VA ECMO cannulation. The drainage cannula is located in the IVC and the reinjection cannula is in the iliac artery/distal descending aorta. c Transthoracic apical four-chamber of a patient with a dilated cardiomyopathy. The cannulae are not visualized on this view but note the presence of an automatic implantable cardioverter defibrillator within the right ventricle
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4591622&req=5

Fig1: Venovenous (VV) and venoarterial (VA) extracorporeal membrane oxygenation (ECMO) configurations and corresponding echocardiographic views. This diagram shows the most common ECMO configurations in our center. (1) Bicannulation VV ECMO (femoro-jugular cannulation) with the drainage cannula in the femoral vein and the reinjection in the superior vena cava (SVC), via the jugular vein. a Mid-esophageal view showing the SVC and reinjection cannula within it (transesophageal echocardiography). b Inferior vena cava (IVC) subcostal view. The drainage cannula is visualized within the IVC in long axis (transthoracic echocardiography). (2) Femoro-femoral VA ECMO cannulation. The drainage cannula is located in the IVC and the reinjection cannula is in the iliac artery/distal descending aorta. c Transthoracic apical four-chamber of a patient with a dilated cardiomyopathy. The cannulae are not visualized on this view but note the presence of an automatic implantable cardioverter defibrillator within the right ventricle
Mentions: The two main configurations of ECMO currently used are VV ECMO, for respiratory support, and venoarterial (VA) ECMO, for cardiorespiratory support (Fig. 1). VV ECMO does not directly provide cardiac support; however, resolution of severe hypoxemia and hypercapnia will decrease the pulmonary vascular resistance, reducing the right ventricle (RV) afterload and improving RV function [12]. This should augment left ventricle (LV) filling. In addition, the institution of VV ECMO usually results in reduction of airway pressures, which also decreases RV afterload. In patients with cardiorespiratory compromise, VA ECMO is the modality of choice and provides full cardiopulmonary support.Fig. 1

Bottom Line: Venoarterial (VA) and venovenous (VV) extracorporeal membrane oxygenation (ECMO) support is increasingly being used in recent years in the adult population.Owing to the underlying disease precipitating severe respiratory or cardiac failure, echocardiography plays an important role in the management of these patients.Nevertheless, there are currently no guidelines on the use of echocardiography in the setting of ECMO support.

View Article: PubMed Central - PubMed

Affiliation: Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, M5G 2N2, Canada. ghislaine.doufle@uhn.ca.

ABSTRACT
Venoarterial (VA) and venovenous (VV) extracorporeal membrane oxygenation (ECMO) support is increasingly being used in recent years in the adult population. Owing to the underlying disease precipitating severe respiratory or cardiac failure, echocardiography plays an important role in the management of these patients. Nevertheless, there are currently no guidelines on the use of echocardiography in the setting of ECMO support. This review describes the current state of application of echocardiography for patients supported with both VA and VV ECMO.

No MeSH data available.


Related in: MedlinePlus