Echocardiography is currently used to guide and check the correct positioning of veno-venous extra-corporeal membrane oxygenation cannulas, both for cannulation guidance, for daily monitoring and for recirculation assessment. In particular,… Click to show full abstract
Echocardiography is currently used to guide and check the correct positioning of veno-venous extra-corporeal membrane oxygenation cannulas, both for cannulation guidance, for daily monitoring and for recirculation assessment. In particular, subcostal and trans-hepatic views easily allow visualizing femoral cannulas and their placement, with respect to the right atrium and suprahepatic veins. If a jugular cannula is placed, transesophageal echocardiography is usually preferred to visualize both femoral and jugular devices in a mid-esophageal bicaval view; this is normally not accessible with a transthoracic parasternal approach because of the lung interposition impeding the visualization of superior vena cava. However, if lung loss of aeration is complete (Fig. 1), the lung is visualized as a tissue-like pattern and its echo-texture is similar to an abdominal parenchyma, thus providing an ideal condition for ultrasound beam penetration. A transthoracic bicaval view can then be performed with the probe aligned with cranio-caudal axis and placed in right mid-clavicular line. A reliable visualization of both femoral and jugular cannulas (Fig. 1a) can be obtained, with accurate reproduction at the bedside of chest X-ray imaging (Fig. 1b) while avoiding irradiation and allowing dynamic assessment on cannula’s functioning and positioning.
               
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