Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting

作者： Subasish Bhowmik1, Yuriy S. Bronshteyn2, Aditi Balakrishna1, John Matthew Bryant1, Marvin G. Chang3, David Convissar4, Loreta Grecu2, Mandisa Jones5, Christina Jelly1 1Department of Anesthesiology,Vanderbilt University Medical Center, 2Department of Anesthesiology,Duke University School of Medicine, Duke University Health System, Durham Veterans Health Administration, 3Department of Anesthesiology, Critical Care, and Pain Medicine,Massachusetts General Hospital, 4Department of Anesthesiology,University of Pittsburgh Medical Center, 5Department of Anesthesiology,Weill Cornell Medical Center

简介：

Overview

This protocol outlines the use of point-of-care ultrasound (POCUS) to monitor patients on peripheral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) without left ventricular venting. It evaluates left ventricular distension, intracardiac or aortic root thrombus, and identifies useful cardiac POCUS parameters for weaning from V-A ECMO.

Key Study Components

Area of Science

• Cardiac monitoring
• Extracorporeal membrane oxygenation (ECMO)
• Point-of-care ultrasound (POCUS)

Background

• Cardiac POCUS is used to monitor patients on VA-ECMO.
• There is variability in provider training regarding POCUS.
• Current guidelines for integrating POCUS into VA-ECMO management are lacking.
• This study aims to fill the knowledge gap in POCUS application during VA-ECMO.

Purpose of Study

• To provide a systematic evidence-based protocol for using POCUS in VA-ECMO.
• To assist clinicians in monitoring patients without left ventricular venting.
• To enhance the consistency of POCUS use among providers.

Methods Used

• Detailed protocol for POCUS image acquisition in VA-ECMO.
• Screening for key pathologies during the maintenance phase of VA-ECMO.
• Incorporation of cardiac POCUS into ECMO weaning.
• Use of sterile gloves and ultrasound jelly for image acquisition.

Main Results

• Identification of left ventricular distension and thrombus.
• Establishment of cardiac POCUS parameters for weaning from V-A ECMO.
• Improved understanding of POCUS application in clinical settings.
• Recommendations for training and protocol adherence.

Conclusions

• Cardiac POCUS is a valuable tool for monitoring patients on VA-ECMO.
• Standardized protocols can enhance patient care and outcomes.
• Further training is needed to improve provider competency in POCUS.

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