![Disclosures
This ongoing imaging interpretation series is proudly sponsored by the
Emergency Medicine Residency Program at Carolinas Medical Center.
Sanger Heart & Vascular clinicians provide expert Cardiology input.
The goal is to promote widespread mastery of imaging interpretation.
There is no personal health information [PHI] within, and all ages have
been changed to protect patient confidentiality.](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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Medical Device Imaging Mastery Project #4: Extracorporeal Membrane Oxygenation
- 1. Imaging Of Medical Devices Extracorporeal Membrane Oxygenation Brandon Friedman, MD1, Kaley El-Arab, MD1, Emily Lipitz, PA2 Departments of Emergency Medicine1 & Internal Medicine2 Carolinas Medical Center & Levine Children’s Hospital John Symanski, MD, Guest Editor, Sanger Heart & Vascular Institute Michael Gibbs, MD, Imaging Mastery Project Lead Editor Medical Device Imaging Mastery Project Presentation #4
- 2. Disclosures This ongoing imaging interpretation series is proudly sponsored by the Emergency Medicine Residency Program at Carolinas Medical Center. Sanger Heart & Vascular clinicians provide expert Cardiology input. The goal is to promote widespread mastery of imaging interpretation. There is no personal health information [PHI] within, and all ages have been changed to protect patient confidentiality.
- 3. Visit Our Website www.EMGuidewire.com For A Complete Archive Of Imaging Presentations And Much More!
- 5. It’s All About The Anatomy!
- 6. Extracorporeal Membrane Oxygenation ECMO Basics
- 7. Extracorporeal Membrane Oxygenation (ECMO) Definition: Extracorporeal mechanism for extended cardiac and pulmonary support for individuals whose heart and lungs are unable to provide adequate gas exchange or perfusion to sustain life. Indication: Acute, severe reversible respiratory or cardiac failure with a high risk of death that is refractory to conventional therapies. Types of ECMO: V-V = veno-venous V-A = veno-arterial
- 8. ECMO Components Air O₂ Sweep Gas O₂ CO₂ CO₂ Pump Oxygenator Blood Deoxygenated Blood Oxygenated Blood Blender Figure 1: ECMO Components The pump modulates flow in in L/min by modifying pump speed in RPM. The blender modifies the FiO₂ by mixing air and oxygen. The oxygenator controls the gas exchange by modifying the sweep volume in L/min.
- 10. V-V ECMO Support for severe pulmonary failure (w/o cardiac failure). Clinical Conditions Appropriate For V-V ECMO • Pneumonia • ARDS • Acute GVHD • Pulmonary contusion • Smoke inhalation • Status asthmaticus • Airway obstruction • Aspiration • Bridge to lung transplant • Drowning
- 11. Figure 2: V-V ECMO Central venous blood is drained and oxygenated blood is returned to the right atrium. This technique requires adequate perfusion by the heart.
- 12. V-V ECMO – Femoro-Jugular Cannulation Figure 3: Femoro-Jugular Cannulation Dual cannula systems drains blood from the IVC through femoral access and returns oxygenated blood to the right atrium via internal jugular access.
- 13. V-V ECMO – Femoro-Femoral Cannulation Figure 3: Femoro-Femoral Cannulation Dual cannula system drains blood from the IVC through femoral access and returns oxygenated blood to the right atrium via the opposite femoral vein.
- 14. V-V ECMO – Single Lumen Cannulation Figure 4: Single Cannula System A single dual-lumen catheter drains blood from the SVC and IVC through small ports and returns blood to the right atrium through a parallel port, requiring a single point of access.
- 16. V-A ECMO Support for cardiac failure (+/- pulmonary failure). Clinical Conditions Appropriate For V-A ECMO • Graft failure post heart or heart lung transplant • Non-ischemic cardiogenic shock • Failure to wean post cardiopulmonary bypass • Bridge to LVAD • Drug overdose • Sepsis • Pulmonary embolus • Cardiac or major vessel trauma • Massive pulmonary hemorrhage • Pulmonary trauma • Acute anaphylaxis
- 17. Figure 5: V-A ECMO Central venous blood is drained and oxygenated blood is returned to the arterial system.
- 18. Extracorporeal Membrane Oxygenation Cases From Carolinas Medical Center
- 19. Case 1: 50-yo in Cardiogenic Shock
- 20. Tip Of Venous ECMO Cannula V-A ECMO Case 1: 50-yo in Cardiogenic Shock
- 21. Case 2: 55-yo with a Large Tracheal Laceration
- 22. Tip of Reinjection Cannula V-V ECMO Case 2: 55-yo with a Large Tracheal Laceration
- 23. Case 3: 28-yo with a Severe Asthma Exacerbation
- 24. Case 3: 28-yo with a Severe Asthma Exacerbation Dual-Lumen RIJ ECMO Cannula V-V ECMO Suction Port Reinjection Port
- 25. Case 4: 47-yo in Cardiogenic Shock
- 26. Tip Of Venous ECMO Cannula V-A ECMO Case 4: 47-yo in Cardiogenic Shock
- 27. Test yourself! Cases From Carolinas Medical Center
- 28. Case 5: 59-yo In Cardiogenic Shock
- 29. Tip of Venous ECMO Cannula V-A ECMO Case 5: 59-yo In Cardiogenic Shock
- 30. Case 6: 30-yo with Necrotizing Pneumonia after Trauma
- 31. Case 6: 30-yo with Necrotizing Pneumonia after Trauma Tip of RIJ Dual-Lumen ECMO Cannula V-V ECMO Suction Port Reinjection Port Suction Port
- 32. Case 7: 64-yo in Cardiogenic Shock
- 33. V-A ECMO Tip Of Venous ECMO Cannula Case 7: 64-yo in Cardiogenic Shock
- 34. Case 8: 70-yo with a Massive PE s/p tPA
- 35. V-A ECMO Case 8: 70-yo with a Massive PE s/p tPA Tip Of Venous ECMO Cannula
- 36. Case 9: 49-yo with Post-Op Pulmonary Edema
- 37. Case 9: 49-yo with Post-Op Pulmonary Edema Tip of Reinjection Cannula V-V ECMO
- 38. Case 9: 49-yo with Post-Op Pulmonary Edema Abdominal View
- 39. Case 9: 49-yo with Post-Op Pulmonary Edema Tip of Suction Cannula V-V ECMO Abdominal View Right Femoral Vein Access
- 40. Case 10: 37-yo with Pulmonary Contusions after an MVC
- 41. Case 10: 37-yo with Pulmonary Contusions after an MVC V-V ECMO Tip of RIJ Dual-Lumen ECMO Cannula Suction Port Reinjection Port Suction Port
- 42. Case 11: 48-yo with a Saddle PE s/p tPA
- 43. Case 11: 48-yo with a Saddle PE s/p tPA V-A ECMO Tip Of Venous ECMO Cannula
- 44. Case 11: 48-yo with a Saddle PE s/p tPA Abdominal View V-A ECMO
- 45. Case 11: 48-yo with a Saddle PE s/p tPA Abdominal View Left Femoral Vein Access V-A ECMO Tip Of Venous ECMO Cannula
- 46. Case 12: 25-yo with Traumatic Pulmonary Hemorrhage
- 47. Case 12: 25-yo with Traumatic Pulmonary Hemorrhage V-V ECMO RIJ Dual-Lumen ECMO Cannula Suction Port Reinjection Port Suction Port
- 48. Case 12: 25-yo with Traumatic Pulmonary Hemorrhage Abdominal View
- 49. Case 12: 25-yo with Traumatic Pulmonary Hemorrhage V-V ECMO Tip of RIJ Dual-Lumen ECMO Cannula Suction Port Reinjection Port Suction Port Abdominal View Right IJ Access
- 50. Case 13: 66-yo with Acute on Chronic Heart Failure
- 51. Case 13: 66-yo with Acute on Chronic Heart Failure V-A ECMO Tip Of Venous ECMO Cannula
- 52. If You Have Interesting Cases Demonstrating ECMO Devices We Invite You To Send A Set Of Digital PDF Images And A Brief Clinical History To: michael.gibbs@atriumhealth.org Your De-Identified Case(s) Will Be Posted On Our Education Website And You And Your Institution Will Be Recognized!
- 53. Selected Embedded References: Banfi C, Pozzi M, Siegenthaler N, Brunner ME, Tassaux D, Obadia JF, Bendjelid K, Giraud R. Veno-venous extracorporeal membrane oxygenation: cannulation techniques. J Thorac Dis. 2016 Dec;8(12):3762-3773. doi: 10.21037/jtd.2016.12.88. PMID: 28149575; PMCID: PMC5227239. Krieger J, Badulak J. The Use of ECMO in Patients with Cardiopulmonary Failure Due to COVID-19. American College of Cardiology. 2020 Aug 4.
- 54. See You Next Month!