Echocardiography-Guided Dual-Lumen Venovenous Extracorporeal Membrane Oxygenation Cannula Placement in the ICU—A Retrospective Review

Griffee, Matthew; Zimmerman, Joshua M.; McKellar, Stephen H.; Tonna, Joseph E.

doi:10.1053/j.jvca.2019.10.024

Cited by 25 publications

(40 citation statements)

References 24 publications

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“…Transesophageal echocardiographic guidance confirms the course of the guidewire to exclude coiling in the right atrium, displacement across the tricuspid valve, crossing the interatrial septum, or entering the carotid sinus. [45][46][47] Transesophageal echocardiographic guidance can ensure that the return cannula is positioned clear of the tricuspid valve or interatrial septum, ensuring that the access and return cannulas are placed with sufficient distance between them to decrease the risk for recirculation. A dual-lumen bicaval cannula may be used and is placed in the right internal jugular traversing from the SVC to inferior vena cava along the posterior aspect of the right atrium.…”

Section: Procedural Guidancementioning

confidence: 99%

Critical Care Transesophageal Echocardiography in Patients during the COVID-19 Pandemic

Teran

Burns

Narasimhan

et al. 2020

Journal of the American Society of Echocardiography

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Background: The COVID-19 pandemic has placed an extraordinary strain on healthcare systems across North America. Defining the optimal approach for managing a critically ill COVID-19 patient is rapidly changing. Goaldirected transesophageal echocardiography (TEE) is frequently used by physicians caring for intubated critically ill patients as a reliable imaging modality that is well suited to answer questions at bedside. Methods: A multidisciplinary (intensive care, critical care cardiology, and emergency medicine) group of experts in point-of-care echocardiography and TEE from the United States and Canada convened to review the available evidence, share experiences, and produce a consensus statement aiming to provide clinicians with a framework to maximize the safety of patients and healthcare providers when considering focused point-of-care TEE in critically ill patients during the COVID-19 pandemic. Results: Although transthoracic echocardiography can provide the information needed in most patients, there are specific scenarios in which TEE represents the modality of choice. TEE provides acute care clinicians with a goal-directed framework to guide clinical care and represents an ideal modality to evaluate hemodynamic instability during prone ventilation, perform serial evaluations of the lungs, support cardiac arrest resuscitation, and guide veno-venous ECMO cannulation. To aid other clinicians in performing TEE during the COVID-19 pandemic, we describe a set of principles and practical aspects for performing examinations with a focus on the logistics, personnel, and equipment required before, during, and after an examination. Conclusions: In the right clinical scenario, TEE is a tool that can provide the information needed to deliver the best and safest possible care for the critically ill patients.

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Section: Procedural Guidancementioning

confidence: 99%

Critical Care Transesophageal Echocardiography in Patients during the COVID-19 Pandemic

Teran

Burns

Narasimhan

et al. 2020

Journal of the American Society of Echocardiography

View full text Add to dashboard Cite

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“…1 In this edition of the Journal of Cardiothoracic and Vascular Anesthesia, Griffee et al present a case review of their own practice using echocardiography during venovenous (VV) ECMO cannulation with a single, dual lumen cannula. 2 There are a variety of cannulation strategies for VV ECMO, the majority of which involve using both the femoral and internal jugular veins. This strategy may cause unnecessary delays in patient care, particularly with regards to patient ambulation, which may be challenging with a large cannula in the femoral vein.…”

mentioning

confidence: 99%

“…There are numerous potential benefits of a single, dual lumen cannula for VV ECMO, including lower sedation requirements, improved extubation, and earlier mobilization. 2,3 Langer et al use the term "awake ECMO" to describe this patient population, which may be spontaneously breathing while on VV ECMO. 3 Langer noted that, in addition to fewer side effects related to sedation and mechanical ventilation, preÀlung transplant patients on "awake ECMO" had shorter durations of postoperative mechanical ventilation and ICU lengths of stay.…”

mentioning

confidence: 99%

“…Griffee et al evaluated their use of echocardiography for initial cannula placement in 45 patients, noting successful placement 87% of the time with echo guidance, and the overwhelming majority (93%) of successful cannulations were without the addition of fluoroscopy. 2 This high degree of successful cannulation without fluoroscopy is important for mobile ECMO programs, where patients may be cannulated in locations where fluoroscopy may not be readily available. The Penn Lung Rescue program, a mobile VV ECMO program based at Penn Presbyterain Medical Center in Philadelphia, uses a portable ultrasound machine with TEE capability for the majority of their ECMO cannulations, which usually occur at the ICU bedside.…”

mentioning

confidence: 99%

“…The subcostal and parasternal short axis (RV inflow-outflow) are useful for evaluating cannula position. 2,8 The authors noted a 4% rate of cannulation of the right ventricle with placement of the single lumen cannula using TEE guidance, which is a potentially catastrophic known complication, which may be prevented with fluoroscopy guidance.…”

mentioning

confidence: 99%

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