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ABSTR ACTBackground Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) as respiratory and circulatory assist therapies are gaining in importance in the treatment of critically ill patients. Depending on the place of cannulation -veno-venous for ECMO and veno-arterial for ECLS -distinct changes in hemodynamics will occur. In this review we describe the different types of ECMO and ECLS systems, the typical cannula placement and frequent complications under therapy. The most suitable imaging modalities will be presented and typical hemodynamic pitfalls in contrast-enhanced computed tomography or angiography will be elucidated. MethodsThe review is based on a literature search in PubMed with the terms "ECMO" and/or "ECLS" and/or "extracorporeal life support" and/or "imaging" and/or "complications". Statistical data was taken from the ECMO register of the "Extracorporeal Life Support Organization (ELSO)".Results Critical illness-and therapy-associated complications are common so that imaging, particularly computed tomography, becomes increasingly important. Following veno-venous cannulation in ECMO, the normal sequential blood flow is preserved, so that no contrast enhancement irregularities should be expected when the right timing and an adequate amount of contrast agent are selected. After veno-arterial cannulation in ECLS, different artifacts like pseudo-filling defects, pseudomembranes and irregular/low contrast enhancement of heart and pulmonary vessels can be found, depending on the site of cannulation and the residual cardiac function.Key points ▪ Cannula placement is usually documented by radiography. This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

Patients with one or more mild-to-moderate non-IRA stenoses had favorable in-hospital outcomes that were comparable with the patients with isolated IRA disease, despite having adverse clinical characteristics that were similar to patients with severe non-IRA stenoses. These results highlight the incremental prognostic importance of angiographical data in patients with ST-elevation myocardial infarction. More research is needed to understand the influence of mild-to-moderate non-IRA stenoses on late outcomes.

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