5, 12, 21, 26, 34
EXPIRED DOCUMENT. It states on its own face that it was scheduled to expire by May 2018, and it does not appear on the ELSO guidelines index as at 6 September 2026. The content remains sound practice and is used throughout Chapter 5, but it must be cited as expired guidance, not as current ELSO policy. The document itself also notes its recommendations are not necessarily consensus recommendations and are not a standard of care.
Three-phase framework. PRE-INITIATION: focused echo aids diagnosis and mode selection (severe LV dysfunction in apparent respiratory failure, acute cor pulmonale, proximal PA embolus); may unmask contraindications (moderate to severe aortic regurgitation precludes VA ECMO); vascular ultrasound identifies vessels, delineates anatomy and measures diameter, with French gauge of cannula = 3 x vessel diameter in mm. DURING INITIATION: real-time ultrasound guidance prevents inadvertent arterial puncture, sapheno-femoral junction cannulation and transfixation of the inguinal ligament; of immense value during pulseless states such as CPR where palpation cannot distinguish artery from vein; femoral anatomy is highly variable so blind surface-landmark technique is frequently inadequate. Guidewire J-loop should be visualised in the IVC or aorta (subcostal view) to avoid ventricular wire placement and arrhythmia and to ensure safe dilatation. TTE first if windows are adequate; TOE if suboptimal; TOE is necessary for bicaval double-lumen cannulation if an image intensifier is not used. POST-INITIATION: echo identifies final cannula position - important because the radiolucent distal end of the cannula is difficult to visualise on radiography - and diagnoses causes of access insufficiency including tamponade. Authors Nanjayya VB and Murphy D; editors Brechot N, Fan E, Pellegrino V, Brodie D.
Ultrasound and echocardiography in ECMO: pre-initiation, during cannulation, and post-initiation