Kashiura M, et al. Effect of ultrasonography and fluoroscopic guidance on the incidence of complications of cannulation in ECPR in out-of-hospital cardiac arrest

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The two imaging modalities answer different questions: ultrasound answers whether the needle is in the right vessel, fluoroscopy answers where the wire has gone. Using both addresses both failure modes.

Cannulation without combined imaging

DOI 10.1186/s12871-016-0293-z

Combined ultrasound plus fluoroscopic guidance for femoral cannulation

Small single-centre retrospective series; no adjustment for era or operator; fluoroscopy availability is itself a marker of a mature system.

Lower incidence of cannulation complications with combined ultrasound and fluoroscopic guidance.

Adults receiving ECPR for out-of-hospital cardiac arrest, single Japanese centre