26, 5, 12, 21
Frequency of surveillance imaging: this document sets no interval, whereas the 2026 imaging review recommends at least twice daily, the 2025 HFA/ESC consensus recommends daily, and the ISCCM Manual frames assessment by stage rather than by clock. None cites evidence.
The document is the only ECMO-specific ultrasound guidance available to this book. Its operational rules are used throughout Chapter 26: the aortic regurgitation exclusion, the vessel-sizing rule, the TTE-first position, the mandatory TOE for dual-lumen bicaval cannulation without fluoroscopy, and the radiolucent-tip argument that a chest film cannot perform cannula surveillance.
Three phases. PRE-INITIATION: a routine focused echocardiogram helps diagnosis and determination of configuration — severe LV dysfunction in severe respiratory failure may change the mode of support; acute cor pulmonale or proximal pulmonary artery emboli confirm the mechanism in massive pulmonary embolism; DETECTION OF SEVERE OR MODERATE-TO-SEVERE AORTIC REGURGITATION PRECLUDES THE PATIENT FROM VA ECMO and it is very important to exclude this before initiation. Vascular ultrasound sizes the vessel: French gauge of cannula = 3 x vessel diameter in mm. DURING INITIATION: real-time ultrasound-guided puncture avoids inadvertent arterial puncture, sapheno-femoral junction cannulation and transfixation of the inguinal ligament, and is of immense value during a pulseless state when artery and vein cannot be told apart by palpation; the guidewire J-loop can be seen in the IVC or aorta on the subcostal view, avoiding ventricular wire placement. TTE first if acoustic windows are adequate; TOE if transthoracic views are suboptimal; FOR A BICAVAL DOUBLE-LUMEN CANNULA IT IS NECESSARY TO USE TOE TO GUIDE CANNULATION IF AN IMAGE INTENSIFIER IS NOT BEING USED. POST-INITIATION: echo identifies final cannula position — particularly important because the radiolucent distal end of the cannula is difficult to visualise on radiography — and diagnoses tamponade causing access insufficiency. On VV ECMO echo has a very important role in evaluating refractory hypoxia; on VA ECMO in evaluating loss of pulsatility, pulmonary oedema and weaning readiness.
Echocardiographic and vascular ultrasound guidance before, during and after ECMO initiation
Authors: Vinodh Bhagyalakshmi Nanjayya (Melbourne) and Deirdre Murphy (Melbourne). Editors: Nicolas Brechot (Paris), Eddy Fan (Toronto), Vin Pellegrino (Melbourne), Dan Brodie (New York).
The document states of itself that these guidelines describe useful and safe practice but are NOT NECESSARILY CONSENSUS RECOMMENDATIONS and are not intended as a standard of care.
CURRENCY WARNING — the document's own text: last updated May 2015, SCHEDULED TO EXPIRE BY MAY 2018, after which users are encouraged to contact the ELSO Guidelines Editorial Board to confirm that it remains in effect. Every statement taken from it in Chapter 26 is therefore more than eleven years old and formally out of date. This is recorded in Chapter 26 §26.18 and in the chapter status callout. Retrieved in full through the project document store.