Application of right heart contrast echocardiography in cannulation of veno-venous extracorporeal membrane oxygenation / 中国医学影像技术

ABSTRACT

Objective: To observe the application value of right heart contrast echocardiography in the cannulation of veno-venous extracorporeal membrane oxygenation (V-V ECMO). Methods: A total of 18 patients with acute respiratory failure caused by severe pneumonia who underwent V-V ECMO treatment were enrolled. The patients were intubated through right femoral vein and right internal jugular vein cannulation, and then were divided into contrast group (n=8) and control group (n=10) according to whether underwent right heart contrast echocardiography during intubation or not. Central venous pressure (CVP) and cardiac output (CO) of all patients were measured and recorded. After the operation of ECMO, patients in contrast group received cardiovascular routine ultrasound examination and right heart contrast echocardiography simultaneously to observe and adjust the position of the cannula tip in the inferior vena cava (IVC), while patients in control group received only cardiovascular routine ultrasound to observe the direction of blood flow at the valve of IVC and the position of cannula tip in IVC. The distance between cannula tip and diaphragm (DCTD) and the left femoral artery partial pressure were measured and recorded. The differences of DCTD, left femoral artery oxygen partial pressure, CVP and CO of 2 groups were compared between 2 groups. Results: DCTD (5.14[4.68,5.81]mm) and left femoral artery oxygen partial pressure in contrast group(90.05[85.06, 95.33]mmHg) were both higher than those in control group (3.31[2.96,3.69]mm, 78.61[71.82,81.04]mmHg, Z=-1.93, -2.20, both P0.05). Conclusion: Right heart contrast echocardiography can help to optimize the position of cannula tip in IVC during intubation of V-V ECMO and improve clinical therapeutic effect by reducing recirculation.