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CRITICAL CARE ECHO ROUNDS: Extracorporeal membrane oxygenation

Echo Research & Practice volume 2, pages D1–D11 (2015)Cite this article

Abstract

Extracorporeal membrane oxygenation (ECMO) is an advanced form of organ support indicated in selected cases of severe cardiovascular and respiratory failure. Echocardiography is an invaluable diagnostic and monitoring tool in all aspects of ECMO support. The unique nature of ECMO, and its distinct effects upon cardio-respiratory physiology, requires the echocardiographer to have a sound understanding of the technology and its interaction with the patient. In this article, we introduce the key concepts underpinning commonly used modes of ECMO and discuss the role of echocardiography.

Case

A 38-year-old lady, with no significant past medical history, was admitted to her local hospital with group A Streptococcal pneumonia. Rapidly progressive respiratory failure ensued and, despite intubation and maximal ventilatory support, adequate oxygenation proved impossible. She was attended by the regional severe respiratory failure service who established her on veno-venous (VV)-ECMO for respiratory support. Systemic oxygenation improved; however, significant cardiovascular compromise was encountered and echocardiography demonstrated a severe septic cardiomyopathy (ejection fraction <15%, aortic velocity time integral 5.9 cm and mitral regurgitation dP/dt 672 mmHg/s). Her ECMO support was consequently converted to a veno-veno-arterial configuration, thus providing additional haemodynamic support. As the sepsis resolved, arterial ECMO support was weaned under echocardiographic guidance; subsequent resolution of intrinsic respiratory function allowed the weaning of VV-ECMO support. The patient was liberated from ECMO 7 days after hospital admission.

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Funding

N A Barrett has received funding for education and research from Maquet, Alung and Corpak.

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Authors and Affiliations

  1. Department of Intensive Care, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Kelly Victor BAppSc, Nicholas A. Barrett FANZCA FCICM, Stuart Gillon BSc MBChB MRCP FFICM, Abigail Gowland BSc, Christopher I. S. Meadows BSc MBBS MRCP FRCA PGCM FFICM & Nicholas Ioannou BA MBBS MA MRCP FRCA FFICM

  2. Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Kelly Victor BAppSc & Abigail Gowland BSc

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  1. Kelly Victor BAppSc
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  2. Nicholas A. Barrett FANZCA FCICM
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Correspondence to Kelly Victor BAppSc.

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Victor, K., Barrett, N.A., Gillon, S. et al. CRITICAL CARE ECHO ROUNDS: Extracorporeal membrane oxygenation. Echo Res Pract 2, D1–D11 (2015). https://doi.org/10.1530/ERP-14-0111

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Echo Research & Practice

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