Extrakorporale Membranoxygenierung bei Erwachsenen – Varianten, Komplikationen unter Therapie und die Rolle der radiologischen Diagnostik

Abstract

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.

Use of Emergency Department Extracorporeal Membrane Oxygenation for Treatment of Acute Necrotizing Myocarditis

“…In the setting of cardiovascular shock, ECMO is an alternative therapy that can bypass the lungs and heart to support gas exchange and circulatory perfusion 12. There are two classifications of ECMO with different indications for initiation.…”

“…There are two classifications of ECMO with different indications for initiation. VA-ECMO is used in cases of treatment-refractory cardiac failure or combined heart and lung failure to maintain systemic perfusion 12. In VA-ECMO, the venously drained blood is oxygenated extracorporeally, bypasses pulmonary circulation, and is returned to the aorta.…”

“…In VA-ECMO, the venously drained blood is oxygenated extracorporeally, bypasses pulmonary circulation, and is returned to the aorta. Indications for VA-ECMO include ventricular dysrhythmias, pulmonary embolism, right and left ventricular failure, sepsis, and cardiac arrest 12,13. In contrast, venovenous ECMO (VV-ECMO) is indicated in severe hypoxemic respiratory distress.…”

“…Venously drained blood is oxygenated and decarboxylated extracorporeally and returned to the right atrium. Indications for VV-ECMO include acute respiratory distress syndrome and hypercapnic failure 12,13…”

Chest X-ray Interpretation: Detecting Devices and Device-Related Complications

“…Even though a CXR is not indicated to monitor the correct functioning of the ECMO circuit, it can still be useful in recognizing the position of ECMO cannulas, considering their variable configuration according to the type of ECMO and the kind of vascular access performed [34,35]. The main complications of IABPs include aortic dissection and malpositioning.…”