Transthoracic echocardiography visualization of bicaval dual lumen catheters for veno‐venous extracorporeal membrane oxygenation

Abstract

Bicaval dual lumen catheters improve the efficiency of veno-venous extracorporeal membrane oxygenation by minimizing recirculation with an innovative design, which requires precise placement of three catheter ports in the superior vena cava, right atrium, and inferior vena cava, respectively. However, the exact position of these catheter ports is usually not known during placement because they cannot be visualized with conventional radiography. We performed a retrospective review of our experience over the past year using transthoracic echocardiography to evaluate the position of the catheter ports. From a subcostal, sagittal imaging approach, we were able to identify all three catheter ports in 11 of 11 studies. At least one of the catheter ports was incorrectly positioned in 5 of 11 studies. Further prospective evaluation is necessary to determine if catheter repositioning based on transthoracic echocardiography findings can further improve the clinical efficiency of veno-venous extracorporeal membrane oxygenation.

Monitoring during extracorporeal membrane oxygenation

“…Chest radiograph is not sufficient to ascertain proper position of the cannula as it does not allow to identify the different portions of the cannula and their relative position to cardiac structures. Echocardiography is best suited to identify the precise positioning of each portion of the cannula [33,34]. Therefore, in presence of persistent hypoxemia, low ECMO flows, the cannula's location should be verified with echocardiography.…”

Echocardiography: Do We Need New Standards for ECMO Patients?

“…This exam may be extended into the ECMO implementation period in some cases to assist with confirmation of wire placement and cannula positioning. 8 Some have advocated for daily echocardiography to evaluate cardiac function and ventricular size while a patient is on VA ECMO. 7 Benefits of this strategy include frequent evaluation for readiness to wean from ECMO and screening the patient for left ventricle distension due to failure to eject.…”

Feasibility of Perflutren Microsphere Contrast Transthoracic Echocardiography in the Visualization of Ventricular Endocardium during Venovenous Extracorporeal Membrane Oxygenation in a Validated Ovine Model

“…It may be utilized in those patients in whom maximal medical therapy has failed and where ECMO support is used to treat a reversible condition or as a bridge to more definitive therapy, such as mechanical cardiac support (MCS) or transplantation . In light of the critical nature of these patients and their dynamic course, echocardiography plays a fundamental role in monitoring and managing patients supported with ECMO …”

“…[9][10][11][12][13] In light of the critical nature of these patients and their dynamic course, echocardiography plays a fundamental role in monitoring and managing patients supported with ECMO. [14][15][16][17][18] Extracorporeal membrane oxygenation patients are managed in a critical care complex, where there are numerous factors which can limit the feasibility of transthoracic echocardiography (TTE). Reasons for this include the recumbency of the patient, positive pressure ventilation, suboptimal lighting conditions, inability to position the patient to optimize the imaging, and sternotomies/drains preventing acquisition of conventional echocardiographic views.…”