26, 25, 16
Narrative synthesis of imaging on ECMO. Supplies: TEE enables real-time assessment of cardiac–ECMO interactions and identification of the watershed zone in VA ECMO, supporting individualised flow optimisation; for contrast-enhanced imaging, reduce extracorporeal flow to the minimum clinically acceptable value, NOT LOWER THAN 1.5 L/min, to move the mixing zone away from the area of diagnostic interest; contrast-enhanced CT on peripheral VA ECMO is distorted by ECMO-related haemodynamic alterations affecting contrast distribution; regular echocardiographic evaluations should be conducted at least twice a day and more frequently during unforeseen instability; RV assessment by TAPSE, fractional area change, right-to-left ventricular ratio over 1, and tricuspid regurgitation velocity; ultrasound guidance reduces haematoma, vascular damage, tamponade and limb ischaemia during cannulation; in peripheral VA ECMO ultrasound cannot show the arterial cannula tip but confirms the guidewire in the aortic lumen. Also surveys low-field bedside MRI and electrical impedance tomography.
Certainty: expert opinion. No validation study of the 1.5 L/min figure is cited; the reasoning is mechanical and sound.
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