Transesophageal echocardiography guidance for bedside extracorporeal membrane oxygenation cannulation in COVID-19 patients

ABSTRACT

Objective: To describe the use and safety of transesophageal echocardiography guidance for bedside ECMO cannulation in a large academic center. Methods: In this retrospective cohort study, we studied all patients who underwent bedside (in the intensive care unit) venovenous ECMO (VV-ECMO) cannulation under TEE guidance between May 4 to November 4, 2020, in a tertiary care center. Patient characteristics, physiological, and ventilatory parameters, as well as echocardiographic findings, were recorded and analyzed. Results: During the study period, 35 patients were placed on VV-ECMO. Nineteen patients (54%) were cannulated under TEE guidance of which sixteen (84%) had a confirmed COVID SARS-COV-2 pneumonia;two patients (11%) had mild to moderate right ventricular systolic dysfunction, and one (5%) had biventricular dysfunction. Cannula position was adequate in 18 cases (95%). No significant complications, such as post-cannulation complications, nosocomial COVID transmission or TEE related complications, were reported during this study. Conclusions: We report the safe utilization of bedside TEE-guidance for VV-ECMO cannulation in patients with severe respiratory failure, including in COVID patients. No TEE related complications, nor nosocomial transmission occurred in our cohort. Besides one superficial vascular injury, we did not encounter significant ECMO related complications.