Extracorporeal Membrane Oxygenation

  • Etiology: long term cardiopulmonary bypass to rest lungs used most often in patients with persistent pulmonary hypertension, congenital diaphragmatic hernia, overwhelming sepsis, post-operative cardiac patients
  • CXR: body wall edema due to being paralyzed on ventilator, complete opacification of lungs
  • CXR: arterial-venous ECMO in neonate – tip of arterial cannula should be in the aortic arch and tip of venous cannula should be in the right atrium
  • CXR: venous-venous ECMO in neonate – tip of venous cannula should be in the right atrium
  • AXR: arterial-venous ECMO in older child – tip of arterial cannula should be in the iliac artery and tip of venous cannula should be in the inferior vena cava
  • CXR: venous-venous ECMO in older child – tip of venous cannula should be near the junction of the right atrium and the inferior vena cava
  • US: neonatal brain needs to be screened before beginning for contraindications to ECMO – pre-existing bleed or brain malformation, brain needs to be screened regularly for intracranial bleeding
  • Complications: catheter malposition, systemic anticoagulation can lead to bleeding anywhere in body but especially in brain so regular surveillance head ultrasound is performed, cerebral atrophy post ECMO
  • Clinical: patients are systemically anticoagulated while on ECMO, patients are sedated while on ECMO making clinical exam very difficult, imaging is in the front line when screening for complications

Cases of Extracorporeal Membrane Oxygenation

CXR of arterial-venous extracorporeal membrane oxygenation (ECMO)
CXR shows normal position of the arterial catheter tip in the aortic arch (aa) and normal position of the venous catheter tip in the right atrium (ra).
CXR of arterial-venous extracorporeal membrane oxygenation (ECMO)
CXR shows normal position of the arterial catheter tip in the aortic arch and normal position of the venous catheter tip in the right atrium, both of which are shifted to the right by the diaphragmatic hernia. Note that the endotracheal tube, which is positioned between the two ECMO catheters, is also shifted to the right.
CXR of venous-venous extracorporeal membrane oxygenation (ECMO)
CXR shows normal position of the venous catheter tip in the right atrium.
CXR of venous-venous extracorporeal membrane oxygenation (ECMO)
CXR shows normal position of the venous catheter tip near the junction of the right atrium and the inferior vena cava.
AXR of arterial-venous extracorporeal membrane oxygenation (ECMO)
AXR shows normal position of the arterial catheter tip in the right iliac artery and normal position of the venous catheter tip in the mid inferior vena cava.
CXR of arterial-venous extracorporeal membrane oxygenation (ECMO)
CXR shows normal position of the arterial catheter tip in the aortic arch and abnormal position of the venous catheter tip (represented by a radio-opaque point) in the superior vena cava. Further advancement of the tip into the right atrium is necessary.
CT of intramuscular hematoma in patient on extracorporeal membrane oxygenation (ECMO)
Axial CT with contrast of the chest shows hematomas in the right sternocleidomastoid muscle (above) near the ECMO catheter insertion site and left pectoralis major muscle.
US of hemothorax in patient on extracorporeal membrane oxygenation (ECMO)
Sagittal and transverse US of the right chest shows a complex fluid collection in the right pleural space.
CT of cerebral atrophy after being on extracorporeal membrane oxygenation (ECMO)
Axial CT without contrast of the brain shows diffuse prominence of the sulci and ventricular system.
US of subdural hematoma and intracerebral hemorrhage in patient on extracorporeal membrane oxygenation (ECMO)
Coronal US of the brain (below) shows echogenic material in right subdural space. Coronal and sagittal US of the brain (above) shows a right parietal round mixed echogenicity lesion.
CT of intraventricular hemorrhage, intracerebral hemorrhage, and cerebral atrophy in a patient on extracorporeal membrane oxygenation (ECMO)
Axial CT without contrast of the brain shows mixed-density fluid in the left lateral ventricle posteriorly and mixed-density fluid in the left parietal-occipital lobe. There is also diffuse prominence of the sulci and ventricular system.
US of intracerebral hemorrhage in a patient on extracorporeal membrane oxygenation (ECMO)
Coronal and sagittal US of the brain shows a large, round echogenic lesion in the left parietal lobe.
CT of intracerebral hemorrhage in a patient on extracorporeal membrane oxygenation (ECMO)
Sagittal, coronal and axial CT without contrast of the brain shows a large, round high density lesion in the right parietal lobe.
CT of cerebellar hemorrhage on extracorporeal membrane oxygenation (ECMO)
Axial and coronal CT without contrast of the brain shows three round mixed density lesions in the cerebellum compressing the fourth ventricle and causing hydrocephalus. The fluid-fluid levels in the lesions were felt to represent active bleeding.