Medical Device Imaging Mastery Project #4: Extracorporeal Membrane ...

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Imaging Of Medical Devices
Extracorporeal Membrane Oxygenation
Brandon Friedman, MD1, Kaley El-Arab, MD1, Emily Lipitz, PA...

Disclosures
 This ongoing imaging interpretation series is proudly sponsored by the
Emergency Medicine Residency Program ...

Visit Our Website
www.EMGuidewire.com
For A Complete Archive Of Imaging Presentations And Much More!

Airway
Bones
Cardiac
Diaphragm
Effusion
Foreign body
Gastric
Hilum

It’s All About The Anatomy!

Extracorporeal Membrane Oxygenation
ECMO Basics

Extracorporeal Membrane Oxygenation (ECMO)
Definition: Extracorporeal mechanism for extended cardiac and pulmonary
support...

ECMO Components
Air
O₂
Sweep
Gas
O₂
CO₂
CO₂
Pump
Oxygenator
Blood
Deoxygenated Blood
Oxygenated Blood
Blender
Figure 1: EC...

Extracorporeal Membrane Oxygenation
V-V ECMO

V-V ECMO
Support for severe pulmonary failure (w/o cardiac failure).
Clinical Conditions Appropriate For V-V ECMO
• Pneumo...

Figure 2: V-V ECMO
Central venous blood is drained and
oxygenated blood is returned to the
right atrium. This technique re...

V-V ECMO – Femoro-Jugular Cannulation
Figure 3: Femoro-Jugular Cannulation
Dual cannula systems drains blood from
the IVC ...

V-V ECMO – Femoro-Femoral Cannulation
Figure 3: Femoro-Femoral Cannulation
Dual cannula system drains blood from
the IVC t...

V-V ECMO – Single Lumen Cannulation
Figure 4: Single Cannula System
A single dual-lumen catheter drains
blood from the SVC...

Extracorporeal Membrane Oxygenation
V-A ECMO

V-A ECMO
Support for cardiac failure (+/- pulmonary failure).
Clinical Conditions Appropriate For V-A ECMO
• Graft failure...

Figure 5: V-A ECMO
Central venous blood is drained and
oxygenated blood is returned to the
arterial system.

Extracorporeal Membrane Oxygenation
Cases From Carolinas Medical Center

Case 1: 50-yo in
Cardiogenic
Shock

Tip Of Venous
ECMO Cannula
V-A ECMO
Case 1: 50-yo in
Cardiogenic
Shock

Case 2: 55-yo
with a Large
Tracheal
Laceration

Tip of Reinjection
Cannula
V-V ECMO
Case 2: 55-yo
with a Large
Tracheal
Laceration

Case 3: 28-yo
with a Severe
Asthma
Exacerbation

Case 3: 28-yo
with a Severe
Asthma
Exacerbation
Dual-Lumen RIJ
ECMO Cannula
V-V ECMO
Suction
Port
Reinjection
Port

Case 4: 47-yo in
Cardiogenic
Shock

Tip Of Venous
ECMO Cannula
V-A ECMO
Case 4: 47-yo in
Cardiogenic
Shock

Test yourself!
Cases From Carolinas Medical Center

Case 5: 59-yo In
Cardiogenic
Shock

Tip of Venous
ECMO Cannula
V-A ECMO
Case 5: 59-yo In
Cardiogenic
Shock

Case 6: 30-yo
with Necrotizing
Pneumonia after
Trauma

Case 6: 30-yo
with Necrotizing
Pneumonia after
Trauma
Tip of RIJ Dual-Lumen
ECMO Cannula
V-V ECMO
Suction
Port
Reinjection...

Case 7: 64-yo in
Cardiogenic
Shock

V-A ECMO
Tip Of Venous
ECMO Cannula
Case 7: 64-yo in
Cardiogenic
Shock

Case 8: 70-yo
with a Massive
PE s/p tPA

V-A ECMO
Case 8: 70-yo
with a Massive
PE s/p tPA
Tip Of Venous
ECMO Cannula

Case 9: 49-yo
with Post-Op
Pulmonary
Edema

Case 9: 49-yo
with Post-Op
Pulmonary
Edema
Tip of Reinjection
Cannula
V-V ECMO

Case 9: 49-yo
with Post-Op
Pulmonary
Edema
Abdominal View

Case 9: 49-yo
with Post-Op
Pulmonary
Edema
Tip of Suction
Cannula
V-V ECMO
Abdominal View
Right Femoral Vein Access

Case 10: 37-yo
with Pulmonary
Contusions after
an MVC

Case 10: 37-yo
with Pulmonary
Contusions after
an MVC
V-V ECMO
Tip of RIJ Dual-Lumen
ECMO Cannula
Suction
Port
Reinjection...

Case 11: 48-yo
with a Saddle PE
s/p tPA

Case 11: 48-yo
with a Saddle PE
s/p tPA
V-A ECMO
Tip Of Venous
ECMO Cannula

Case 11: 48-yo
with a Saddle PE
s/p tPA
Abdominal View
V-A ECMO

Case 11: 48-yo
with a Saddle PE
s/p tPA
Abdominal View
Left Femoral Vein Access
V-A ECMO
Tip Of Venous
ECMO Cannula

Case 12: 25-yo
with Traumatic
Pulmonary
Hemorrhage

Case 12: 25-yo
with Traumatic
Pulmonary
Hemorrhage
V-V ECMO
RIJ Dual-Lumen
ECMO Cannula Suction
Port
Reinjection
Port
Suct...

Case 12: 25-yo
with Traumatic
Pulmonary
Hemorrhage
Abdominal View

Case 12: 25-yo
with Traumatic
Pulmonary
Hemorrhage
V-V ECMO
Tip of RIJ Dual-Lumen
ECMO Cannula
Suction
Port
Reinjection
Po...

Case 13: 66-yo
with Acute on
Chronic Heart
Failure

Case 13: 66-yo
with Acute on
Chronic Heart
Failure
V-A ECMO
Tip Of Venous
ECMO Cannula

If You Have Interesting Cases Demonstrating ECMO Devices We Invite You To
Send A Set Of Digital PDF Images And A Brief Cli...

Selected Embedded References:
Banfi C, Pozzi M, Siegenthaler N, Brunner ME, Tassaux D, Obadia JF, Bendjelid K,
Giraud R. V...

See You Next Month!

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