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. 2014 Dec;2(1):2.
doi: 10.1186/2197-425X-2-2. Epub 2014 Feb 6.

A novel echocardiographic imaging technique, intracatheter echocardiography, to guide veno-venous extracorporeal membrane oxygenation cannulae placement in a validated ovine model

David G Platts  1 , Andrew Hilton, Sara Diab, Charles McDonald, Matthew Tunbridge, Saul Chemonges, Kimble R Dunster, Kiran Shekar, Darryl J Burstow, John F Fraser
Affiliations

A novel echocardiographic imaging technique, intracatheter echocardiography, to guide veno-venous extracorporeal membrane oxygenation cannulae placement in a validated ovine model

David G Platts et al. Intensive Care Med Exp. 2014 Dec.

Abstract

Background: Echocardiography plays a fundamental role in cannulae insertion and positioning for extracorporeal membrane oxygenation (ECMO). Optimal access and return cannulae orientation is required to prevent recirculation. The aim of this study was to compare a novel imaging technique, intracatheter echocardiography (iCATHe), with conventional intracardiac echocardiography (ICE) to guide placement of ECMO access and return venous cannulae.

Methods: Twenty sheep were commenced on veno-venous ECMO (VV ECMO). Access and return ECMO cannulae were positioned using an ICE-guided technique. Following the assessment of cannulae position, the ICE probe was then introduced inside the cannulae, noting location of the tip. After 24 h, the sheep were euthanized and cannulae position was determined at post mortem. The two-tailed McNemar test was used to compare iCATHe with ICE cannulae positioning.

Results: ICE and iCATHe imaging was possible in all 20 sheep commenced on ECMO. There was no significant difference between the two methods in assessing access cannula position (proportion correct for each 90%, incorrect 10%). However, there was a significant difference between ICE and iCATHe success rates for the return cannula (p = 0.001). Proportion correct for iCATHe and ICE was 80% and 15% respectively. iCATHe was 65% more successful (95% CI 27% to 75%) at predicting the placement of the return cannula. There were no complications related to the ICE or iCATHe imaging.

Conclusion: iCATHe is a safe and feasible imaging technique to guide real-time VV ECMO cannulae placement and improves accuracy of return cannula positioning compared to ICE.

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Figures

Figure 1
Figure 1
19 F ECMO cannula. Note the main body of the cannula with circumferential metal wiring for radial structural support and the distal tip composed of polyurethane with multiple side holes and a main central lumen at the end.
Figure 2
Figure 2
iCATHe image acquired whilst within the metallic component of the cannula. Note the continuous linear metal reflective signal.
Figure 3
Figure 3
iCATHe image acquired whilst within the polyurethane tip. Note the perfusion/flow side holes.
Figure 4
Figure 4
iCATHe image of an access cannula within the inferior vena cava. Note the transition from the metallic component of the cannula (right side of image) to the polyurethane tip of the cannula (left side of the image, with a side hole on view).
Figure 5
Figure 5
An iCATHe image as the tip of the ICE probe just exits out the end of the ECMO cannula. Note the clear visualisation of the tricuspid vale, right ventricle and end of the ECMO cannula.
Figure 6
Figure 6
ICE versus iCATHe results for the access cannula.
Figure 7
Figure 7
ICE versus iCATHe results for the return cannula.
Figure 8
Figure 8
Plain chest x-ray of a sheep during VV ECMO. Note the visualisation of only the access cannula within the inferior vena cava.
See this image and copyright information in PMC

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