Background Sepsis is a leading cause of death and it is characterized not only by profound vasoplegia but also by myocardial dysfunction. Critical care echocardiography is the preferred modality for the initial assessment of the cause of shock. Moreover, it can be extremely helpful in the identification of progressing myocardial dysfunction during the course of sepsis, also known as septic cardiomyopathy. Main body One of the issues in the identification of septic cardiomyopathy is that it can be manifest with different clinical phenotypes, from overt biventricular dysfunction to isolated left ventricular (LV) systolic and/or diastolic dysfunction, from right ventricular (RV) systolic dysfunction to RV failure and dilatation. However, the commonly used echocardiography parameters for the assessment of LV and/or RV function are not always entirely reliable. Indeed, these are influenced by variable preload and afterload conditions imposed by critical illness such as fluid shifts, sedation level and mechanical ventilation with positive pressure. Conclusions Strain echocardiography is a promising tool for the early identification of myocardial dysfunction in the context of sepsis. Studies reporting data on strain echocardiography should be particularly detailed in order to increase the reproducibility of results and to favor comparison with future studies.

Background Veno-arterial Extracorporeal Membrane Oxygenation (VA-ECMO) is a rescue treatment in refractory cardiogenic shock (CS) or refractory cardiac arrest (CA). Exposure to hyperoxemia is common during VA-ECMO, and its impact on patient’s outcome remains unclear. Methods We conducted a systematic review (PubMed and Scopus) and metanalysis investigating the effects of exposure to hyperoxemia on mortality and poor neurological outcome in patients supported by VA-ECMO. Whenever provided, we used the Odds Ratio (OR) adjusted for confounders. Results are reported as OR and 95% confidence interval (CI). Subgroup analyses were conducted according to VA-ECMO indication and hyperoxemia thresholds. Results Data from 11 observational studies were included. Ten studies reported data on mortality (6 on refractory CA and 4 on CS), and 4 on neurological outcome. Hyperoxemia exposure was associated with higher mortality (OR:1.81, 95%CI [1.22–2.71]; p = 0.003; I2 = 81%) and worse neurological outcome (OR:1.97, 95%CI [1.30–2.96]; p = 0.001; I2 = 0%). Magnitude and effect of these findings remained valid in subgroup analyses conducted according to different hyperoxemia thresholds (> 200 or > 300 mmHg) and VA-ECMO indication, although the association with mortality remained uncertain in the refractory CA population (p = 0.07). Analysis restricted only to studies providing data in adjusted OR confirmed the increased mortality (OR:1.72, 95%CI [1.00-2.97]; p = 0.05) and poorer neurological outcome (OR:1.99, 95%CI [1.18–3.37]; p = 0.01) in patients exposed to hyperoxemia. Conclusions Hyperoxemia exposure after initiation of VA-ECMO is associated with an almost doubled increased probability of poor neurological outcome and mortality. Clinical efforts should be made to avoid severe hyperoxemia during VA-ECMO support.