Imaging adults on extracorporeal membrane oxygenation (ECMO)

Area of Science:

• Radiology
• Cardiology
• Critical Care Medicine

Background:

• Extracorporeal membrane oxygenation (ECMO) is increasingly utilized in adult patients experiencing cardiac surgery complications or severe respiratory failure.
• Accurate interpretation of ECMO imaging requires knowledge of circuit types, cannula positions, and potential complications.

Purpose of the Study:

• To describe the imaging appearance of various adult ECMO circuits.
• To outline commonly encountered complications associated with ECMO.

Main Methods:

• Review of imaging characteristics for different ECMO configurations (VV and VA).
• Identification and description of typical ECMO-related complications.
• Discussion of imaging optimization strategies for patients undergoing CT angiography.

Main Results:

• Detailed descriptions of femoroatrial, femorofemoral, dual-lumen single cannula VV ECMO, and peripheral/central VA ECMO circuits.
• Common complications include cannula malposition, hemorrhage, stroke, thrombus formation, and distal emboli.
• CT angiography may require ECMO flow adjustment or temporary disabling for optimal contrast visualization.

Conclusions:

• Familiarity with ECMO circuit variations and their imaging manifestations is essential for radiologists.
• Recognizing and understanding ECMO complications aids in timely diagnosis and patient care.
• Strategies exist to optimize CT angiography in patients on ECMO, ensuring diagnostic accuracy.