{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:27:32Z","timestamp":1753878452344,"version":"3.41.2"},"reference-count":23,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2024,7,9]],"date-time":"2024-07-09T00:00:00Z","timestamp":1720483200000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Echocardiography is considered essential during cannulation placement and manipulations. Literature evaluating transthoracic echocardiography (TTE) usage during pediatric VV\u2010ECMO is scant. The purpose of this study is to describe the use of echocardiography during VV\u2010ECMO at a large, quaternary children's hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective, single\u2010year cohort study was performed of pediatric patients on VV\u2010ECMO via dual\u2010lumen cannula at our institution from January 2019 through December 2019. For each echocardiogram, final cannula component (re\u2010infusion port (ReP), distal tip, proximal port and distal port) positions were evaluated by one echocardiographer. For TTEs with ReP in the right atrium, two echocardiographers independently evaluated ReP direction using 2\u2010point (Yes\/No) and 4\u2010point scales, which were semi\u2010quantitative protocols using color Doppler images to estimate ReP jet direction to the tricuspid valve. Cohen's kappa or weighted kappa was used to measure interrater agreement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During study period, 11 patients (64% male) received VV\u2010ECMO with 49 TTEs and one transesophageal echocardiogram performed. The median patient age was 4.3 years [IQR: 1.1\u201311.5] and median VV\u2010ECMO run time of 192\u00a0h [90\u2013349]. The median time between TTEs on VV\u2010ECMO was 34\u00a0h [8.3\u201365]. Most common position for the ReP was the right atrium (<jats:italic>n<\/jats:italic>\u00a0=\u00a033, 67%), and ReP location was not identified in five TTEs (10%). For ReP flow direction, echocardiographers agreed on 82% of TTEs using 2\u2010point evaluation. There was only moderate agreement between echocardiographers on the 2\u2010point and 4\u2010point assessments (<jats:italic>k<\/jats:italic>\u00a0=\u00a0.54, kw\u00a0=\u00a0.46 respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>TTE is the predominant cardiac ultrasound modality used during VV\u2010ECMO for pediatric respiratory failure. Subjective evaluation of VV\u2010ECMO ReP jet direction in the right atrium is challenging, regardless of assessment method.<\/jats:p><\/jats:sec>","DOI":"10.1111\/echo.15878","type":"journal-article","created":{"date-parts":[[2024,7,9]],"date-time":"2024-07-09T11:21:06Z","timestamp":1720524066000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessment of echocardiographic interpretation of dual\u2010lumen cannula during venovenous extracorporeal membrane oxygenation use for pediatric respiratory failure"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0114-6928","authenticated-orcid":false,"given":"Alan F.","family":"Riley","sequence":"first","affiliation":[{"name":"Department of Pediatrics Lillie Frank Abercrombie Division of Pediatric Cardiology Baylor College of Medicine\u2010Texas Children's Hospital  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachael","family":"Rose","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Division of Critical Care Medicine Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Denfield","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James A.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Division of Critical Care Medicine Baylor College of Medicine\u2010Texas Children's Hospital  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam M.","family":"Vogel","sequence":"additional","affiliation":[{"name":"Department of Surgery Division of Pediatric Surgery Baylor College of Medicine\u2010Texas Children's Hospital  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan","family":"Coleman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Division of Critical Care Medicine Baylor College of Medicine\u2010Texas Children's Hospital  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fong Wilson","family":"Lam","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Division of Critical Care Medicine Baylor College of Medicine\u2010Texas Children's Hospital  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,7,9]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2019-3564"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1586\/ers.12.31"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00383-018-4225-5"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.4103\/jpcc.jpcc_65_23"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/000313481608200937"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e3182a5540d"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.05338"},{"volume-title":"Identification and management of recirculation in venovenous ECMO","year":"2015","author":"Abrams 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