{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:50:46Z","timestamp":1787028646578,"version":"build-2736575974"},"reference-count":50,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,4,30]],"date-time":"2024-04-30T00:00:00Z","timestamp":1714435200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Veno-arterial (V-A) and Veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) support is increasingly utilized for acute cardiogenic shock and\/or respiratory failure. Echocardiography and point-of-care ultrasonography (POCUS) play a critical role in the selection and management of these critically ill patients, however, there are limited guidelines regarding their application. This comprehensive review describes current and potential application of echocardiography and POCUS for pre-ECMO assessment and patient selection, cannulation guidance with emphasis on dual-lumen configurations, diagnosis of ECMO complications and trouble-shooting of cannula malposition, diagnosis of common cardiac or pulmonary pathologies, and assessment of ECMO weaning appropriateness including identification of the aortic mixing point in V-A ECMO.<\/jats:p>","DOI":"10.3390\/jcm13092630","type":"journal-article","created":{"date-parts":[[2024,4,30]],"date-time":"2024-04-30T04:01:52Z","timestamp":1714449712000},"page":"2630","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Echocardiographic and Point-of-Care Ultrasonography (POCUS) Guidance in the Management of the ECMO Patient"],"prefix":"10.3390","volume":"13","author":[{"given":"Stephanie","family":"Cha","sequence":"first","affiliation":[{"name":"Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street Suite 6216, Baltimore, MD 21287, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan P.","family":"Kostibas","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street Suite 6216, Baltimore, MD 21287, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,30]]},"reference":[{"key":"ref_1","unstructured":"ELSO (2024, January 12). ECLS Registry Report: International Summary 2023. Available online: https:\/\/www.elso.org\/registry\/internationalsummaryandreports\/internationalsummary.aspx."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1097\/MAT.0000000000001510","article-title":"ELSO interim guidelines for venoarterial extracorporeal membrane oxygenation in adult cardiac patients","volume":"67","author":"Lorusso","year":"2021","journal-title":"ASAIO J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1097\/MAT.0000000000001432","article-title":"Management of adult patients supported with venovenous extracorporeal membrane oxygenation (VV ECMO): Guideline from the extracorporeal life support organization (ELSO)","volume":"67","author":"Tonna","year":"2021","journal-title":"ASAIO J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1097\/MAT.0000000000000475","article-title":"Extracorporeal life support organization registry international report 2016","volume":"63","author":"Thiagarajan","year":"2016","journal-title":"ASAIO J."},{"key":"ref_5","unstructured":"Brogan, T.V., Lequier, L., Lorusso, R., Maclaren, G., and Peek, G. (2024, January 10). Extracorporeal Life Support: The Elso Red Book. Extracorporeal Life Support Organization. Available online: https:\/\/explore.openaire.eu\/search\/result?id=narcis______::2ffe35a1296ee89ba31d437893feb84d."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e1269","DOI":"10.1097\/CCM.0000000000004688","article-title":"Vascular complications of extracorporeal membrane oxygenation: A systematic review and meta-regression analysis","volume":"48","author":"Jia","year":"2020","journal-title":"Crit. Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1186\/s13054-019-2541-3","article-title":"Limb ischemia in peripheral veno-arterial extracorporeal membrane oxygenation: A narrative review of incidence, prevention, monitoring, and treatment","volume":"23","author":"Bonicolini","year":"2019","journal-title":"Crit. Care"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1097\/CCM.0000000000005819","article-title":"Real-time ultrasound guidance as compared with landmark technique for subclavian central venous cannulation: A systematic review and meta-analysis with trial sequential analysis","volume":"51","author":"Zawadka","year":"2023","journal-title":"Crit. Care Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.ajem.2024.01.043","article-title":"Ultrasound-guided central venous catheterization around the neck: Systematic review and network meta-analysis","volume":"78","author":"Imai","year":"2024","journal-title":"Am. J. Emerg. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e29489","DOI":"10.1097\/MD.0000000000029489","article-title":"Impact factors of POCUS-guided cannulation for peripheral venoarterial extracorporeal membrane oxygenation: One single-center retrospective clinical analysis","volume":"101","author":"Chen","year":"2022","journal-title":"Medicine"},{"key":"ref_11","first-page":"46","article-title":"Role of ultrasound in the critical ill patient with ECMO","volume":"48","year":"2024","journal-title":"Med. Intensiv."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1097\/MCC.0b013e328342722b","article-title":"Acute respiratory distress syndrome, mechanical ventilation, and right ventricular function","volume":"17","author":"Bouferrache","year":"2011","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1007\/s00134-023-07147-z","article-title":"Echocardiography phenotypes of right ventricular involvement in COVID-19 ARDS patients and ICU mortality: Post-hoc (exploratory) analysis of repeated data from the ECHO-COVID study","volume":"49","author":"Huang","year":"2023","journal-title":"Intensiv. Care Med."},{"key":"ref_14","unstructured":"Bhagyalakshmi, V., and Murphy, D. (2024, January 12). Ultrasound Guidance for Extra-Corporeal Membrane Oxygenation General Guidelines. Available online: https:\/\/www.elso.org\/portals\/0\/files\/elso_ultrasoundguideance_ecmogeneral_guidelines_may2015.pdf."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.jss.2018.07.030","article-title":"Echocardiographic guidance during neonatal and pediatric jugular cannulation for ECMO","volume":"232","author":"Salazar","year":"2018","journal-title":"J. Surg. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"740853","DOI":"10.3389\/fped.2021.740853","article-title":"COVID-19 Pneumomediastinum: Possible role of transesophageal echo in bedside percutaneous bicaval double-lumen ECMO cannulation in children. A Case Report","volume":"9","author":"Moscatelli","year":"2021","journal-title":"Front. Pediatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.jemermed.2017.12.013","article-title":"Point-of-care ultrasound\u2013guided percutaneous cannulation of extracorporeal membrane oxygenation: Make it simple","volume":"54","author":"Ahn","year":"2018","journal-title":"J. Emerg. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.resuscitation.2017.11.057","article-title":"Improving cannulation time for extracorporeal life support in refractory cardiac arrest of presumed cardiac cause\u2014Comparison of two percutaneous cannulation techniques in the catheterization laboratory in a center without on-site cardiovascular surgery","volume":"122","author":"Voicu","year":"2018","journal-title":"Resuscitation"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1007\/s10047-014-0810-0","article-title":"Impact of bypass flow rate and catheter position in veno-venous extracorporeal membrane oxygenation on gas exchange in vivo","volume":"18","author":"Togo","year":"2014","journal-title":"J. Artif. Organs"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1097\/MAT.0000000000001795","article-title":"How to do it: A safe bedside protocol for dual-lumen right internal jugular cannulation for venovenous extracorporeal membrane oxygenation in COVID-19 patients with severe acute respiratory distress syndrome","volume":"69","author":"Cha","year":"2022","journal-title":"ASAIO J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2080","DOI":"10.1053\/j.jvca.2021.04.031","article-title":"Contrast-enhanced echocardiography application in patients supported by extracorporeal membrane oxygenation (ECMO): A narrative review","volume":"36","author":"Lashin","year":"2022","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"283","DOI":"10.4103\/aca.ACA_75_19","article-title":"Transesophageal echocardiography compared to fluoroscopy for avalon bicaval dual-lumen cannula positioning for venovenous ECMO","volume":"23","author":"Hemamalini","year":"2020","journal-title":"Ann. Card. Anaesth."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1053\/j.jvca.2019.10.024","article-title":"Echocardiography-guided dual-lumen venovenous extracorporeal membrane oxygenation cannula placement in the ICU\u2014A retrospective review","volume":"34","author":"Griffee","year":"2020","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"4296","DOI":"10.1053\/j.jvca.2022.07.020","article-title":"Transesophageal echocardiography-guided extracorporeal membrane oxygenation cannulation in COVID-19 patients","volume":"36","author":"Castro","year":"2022","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.1097\/CCM.0000000000001847","article-title":"Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically Ill patients\u2014Part II: Cardiac ultrasonography","volume":"44","author":"Levitov","year":"2016","journal-title":"Crit. Care Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1378\/chest.14-1313","article-title":"BLUE-protocol and FALLS-protocol","volume":"147","author":"Lichtenstein","year":"2015","journal-title":"Chest"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1097\/MAT.0000000000001592","article-title":"Extracorporeal membrane oxygenation blood flow and blood recirculation compromise thermodilution-based measurements of cardiac output","volume":"68","author":"Russ","year":"2021","journal-title":"ASAIO J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1111\/echo.15266","article-title":"Echocardiography for extracorporeal membrane oxygenation","volume":"39","author":"Hussey","year":"2023","journal-title":"Echocardiography"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s40635-016-0079-0","article-title":"Quantification of perflutren microsphere contrast destruction during transit through an ex vivo extracorporeal membrane oxygenation circuit","volume":"4","author":"Platts","year":"2016","journal-title":"Intensiv. Care Med. Exp."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.jcmg.2013.10.012","article-title":"3D TEE during catheter-based interventions","volume":"7","author":"Faletra","year":"2014","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e023713","DOI":"10.1161\/JAHA.121.023713","article-title":"Outcomes of venoarterial extracorporeal membrane oxygenation plus intra-aortic balloon pumping for treatment of acute myocardial infarction complicated by cardiogenic shock","volume":"11","author":"Nishi","year":"2022","journal-title":"J. Am. Heart Assoc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2610","DOI":"10.1002\/ehf2.13981","article-title":"Intra-aortic balloon pump impacts the regional haemodynamics of patients with cardiogenic shock treated with femoro-femoral veno-arterial extracorporeal membrane oxygenation","volume":"9","author":"Xu","year":"2022","journal-title":"ESC Heart Fail."},{"key":"ref_33","first-page":"40","article-title":"Positioning an intraaortic balloon pump using intraoperative transesophageal echocardiogram guidance","volume":"113","author":"Klopman","year":"2011","journal-title":"Obstet. Anesth. Dig."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Kuckelman, J., Coffey, P., Sharkawi, M., Bailey, C., Hiner, E., and Patel, V. (2024). ECPELLA: Beyond a left ventricular venting strategy when to unload the left ventricle and how to decide. ASAIO J., Online-ahead of print.","DOI":"10.1097\/MAT.0000000000002146"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2663","DOI":"10.1053\/j.jvca.2019.01.048","article-title":"transesophageal echocardiography for impella placement and management","volume":"33","author":"Crowley","year":"2019","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Fields, J.M., Davis, J., Girson, L., Au, A., Potts, J., Morgan, C.J., Vetter, I., and Riesenberg, L.A. (2017). Transthoracic echocardiography for diagnosing pulmonary embolism: A systematic review and meta-analysis. J. Am. Soc. Echocardiogr., 30.","DOI":"10.1016\/j.echo.2017.03.004"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1853","DOI":"10.1016\/j.chest.2021.07.010","article-title":"Point-of-Care ultrasound for bedside diagnosis of lower extremity DVT","volume":"160","author":"Patel","year":"2021","journal-title":"Chest"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.athoracsur.2019.10.053","article-title":"Predictors of recovery in patients supported with venoarterial extracorporeal membrane oxygenation for acute massive pulmonary embolism","volume":"110","author":"Ghoreishi","year":"2020","journal-title":"Ann. Thorac. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2685","DOI":"10.1111\/jocs.15622","article-title":"Ultrasound-assisted catheter directed thrombolysis for pulmonary embolus during extracorporeal membrane oxygenation","volume":"36","author":"Tran","year":"2021","journal-title":"J. Card. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1177\/1753465815621251","article-title":"The potential role and limitations of echocardiography in acute respiratory distress syndrome","volume":"10","author":"Lazzeri","year":"2016","journal-title":"Ther. Adv. Respir. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Mu\u00f1oz-Rodr\u00edguez, R., Garc\u00eda-Gonz\u00e1lez, M.J., Jorge-P\u00e9rez, P., Mart\u00edn-Cabeza, M.M., Izquierdo-G\u00f3mez, M.M., Mar\u00ed-L\u00f3pez, B., Duque-Gonz\u00e1lez, M.A., Barrag\u00e1n-Acea, A., and Lacalzada-Almeida, J. (2021). Ultrasound assessment in cardiogenic shock weaning: A review of the state of the art. J. Clin. Med., 10.","DOI":"10.3390\/jcm10215108"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1186\/s13054-015-1042-2","article-title":"Echocardiography for adult patients supported with extracorporeal membrane oxygenation","volume":"19","author":"Roscoe","year":"2015","journal-title":"Crit. Care"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1053\/j.jvca.2022.11.004","article-title":"Bivalirudin and venoarterial extracorporeal membrane oxygenation for treatment of massive pulmonary embolism from heparin-induced thrombocytopenia with thrombosis","volume":"37","author":"Kawaji","year":"2023","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e190703","DOI":"10.1001\/jamanetworkopen.2019.0703","article-title":"Diagnostic accuracy of point-of-care lung ultrasonography and chest radiography in adults with symptoms suggestive of acute decompensated heart failure","volume":"2","author":"Maw","year":"2019","journal-title":"JAMA Netw. Open"},{"key":"ref_45","first-page":"41","article-title":"Focused cardiac and lung ultrasonography: Implications and applicability in the perioperative period","volume":"23","author":"Via","year":"2016","journal-title":"Rom. J. Anaesth. Intensiv. Care"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1177\/03913988211051395","article-title":"Lung ultrasound and the role of lung aeration score in patients with acute respiratory distress syndrome on extracorporeal membrane oxygenation","volume":"44","author":"Curry","year":"2021","journal-title":"Int. J. Artif. Organs"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1177\/0391398820948870","article-title":"Lung ultrasound score as an indicator of dynamic lung compliance during veno-venous extra-corporeal membrane oxygenation","volume":"44","author":"Ntoumenopoulos","year":"2021","journal-title":"Int. J. Artif. Organs"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"M\u00f8ller-S\u00f8rensen, H., Gjedsted, J., J\u00f8rgensen, V.L., and Hansen, K.L. (2020). COVID-19 assessment with bedside lung ultrasound in a population of intensive care patients treated with mechanical ventilation and ECMO. Diagnostics, 10.","DOI":"10.3390\/diagnostics10070447"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.hrtlng.2023.09.006","article-title":"Lung ultrasound score for monitoring the withdrawal of extracorporeal membrane oxygenation on neonatal acute respiratory distress syndrome","volume":"63","author":"Wu","year":"2024","journal-title":"Heart Lung"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.4187\/respcare.06907","article-title":"Ultrasound assessment of lung aeration in subjects supported by venovenous extracorporeal membrane oxygenation","volume":"64","author":"Lu","year":"2019","journal-title":"Respir. Care"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/9\/2630\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:36:40Z","timestamp":1760107000000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/9\/2630"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,30]]},"references-count":50,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["jcm13092630"],"URL":"https:\/\/doi.org\/10.3390\/jcm13092630","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,30]]}}}