Ultrasound has become indispensable in the management of patients supported with extracorporeal membrane oxygenation (ECMO), enabling rapid diagnosis, procedural guidance, physiologic monitoring, and informed decision-making across the entire ECMO continuum. This review, conducted under the auspices of the Extracorporeal Life Support Organization (ELSO), provides evidence-based recommendations for the use of ultrasound in adult, pediatric, and neonatal ECMO patients. An international, multidisciplinary panel of experts with dual expertise in ECMO and ultrasound, representing all ELSO chapters, convened to define the scope and structure of the review. A comprehensive literature review identified 133 relevant publications informing recommendations. The review addresses training and competency requirements, choice of ultrasound modalities, and the role of ultrasound before ECMO initiation, during cannulation, throughout ECMO support, for troubleshooting complications, and during ECMO weaning and post-decannulation care. Pre-ECMO ultrasound is emphasized for assessment of cardiopulmonary function, vascular anatomy, and identification of contraindications or reversible conditions. Real-time ultrasound guidance is recommended for cannulation to reduce complications and confirm optimal cannula positioning. During ECMO, echocardiography and extracardiac ultrasound are central to monitoring cardiac function, cannula position, ventricular loading conditions, pulmonary pathology, neurological complications, and vascular integrity. Ultrasound-based strategies for diagnosing hypoxemia, recirculation, tamponade, ventricular distension, and limb ischemia are detailed. Finally, ultrasound plays a critical role in assessing readiness for ECMO liberation and identifying post-ECMO complications. This review highlights the pervasive role of ultrasound as a core competency in ECMO care and provides a practical framework to support safe, effective, and standardized ultrasound use across diverse ECMO programs worldwide.

Cardiothoracic Intensive Care Unit Department of Cardiac Thoracic and Vascular Surgery National University Heart Centre National University Health System Singapore

Clínic Somer Critical Care Medicine Rionegro Antioquia Colombia

Critical Care Research Group and Institute for Molecular Biosciences The University of Queensland Brisbane Queensland Australia

Department of Anesthesia and Pain Management Toronto General Hospital Toronto Ontario Canada

Department of Anesthesiology and Intensive Care 1st Faculty of Medicine Charles University and General University Hospital Prague Czechia EU

Departments of Cardiology and Intensive Care Royal Brompton and Harefield NHS Foundation Trust London United Kingdom

From the Interdepartmental Division of Critical Care Medicine of the University of Toronto Toronto Ontario Canada

Initiative to Develop African Research Leaders KEMRI Wellcome Trust Research Programme Kilifi Kilifi County Kenya

National Heart and Lung Institute Imperial College London London United Kingdom

Pediatric Cardiology Department Hospital de Santa Marta Unidade Local de Saude São Jose Lisboa Portugal

Pediatric Cardiovascular Unit King Fahad Medical City Riyadh Saudi Arabia

Pediatric Intensive Care Unit Bambino Gesù Children's Hospital IRCCS Rome Italy

Uniformed Services University of the Health Sciences Bethesda Maryland

United States Air Force Department of Pediatrics Brooke Army Medical Center San Antonio Texas

Wellcome Trust Centre for Global Health Research Imperial College London London United Kingdom

Yong Loo Lin School of Medicine National University of Singapore National University Health System Singapore

Zobrazit více v PubMed

Combes A, Brodie D, Bartlett R, et al. ; International ECMO Network (ECMONet): Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients. Am J Respir Crit Care Med. 190: 488–496, 2014. PubMed

Abrams D, Garan AR, Abdelbary A, et al. ; International ECMO Network (ECMONet) and The Extracorporeal Life Support Organization (ELSO): Position paper for the organization of ECMO programs for cardiac failure in adults. Intensive Care Med. 44: 717–729, 2018. PubMed

Hahn RT, Abraham T, Adams MS, et al. : Guidelines for performing a comprehensive transesophageal echocardiographic examination: Recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr. 26: 921–964, 2013. PubMed

Kirkpatrick JN, Panebianco N, Diaz-Gomez JL, et al. : Recommendations for cardiac point-of-care ultrasound nomenclature. J Am Soc Echocardiogr. 24: S0894-7317, 2024. doi:10.1016/j.echo.2024.05.001. PubMed

Mitchell C, Rahko PS, Blauwet LA, et al. : Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 32: 1–64, 2019. PubMed

Kirkpatrick JN, Grimm R, Johri AM, et al. : Recommendations for echocardiography laboratories participating in cardiac point of care cardiac ultrasound (POCUS) and critical care echocardiography training: Report from the American Society of Echocardiography. J Am Soc Echocardiogr. 33: 409–422.e4, 332020. PubMed

Rajamani A, Galarza L, Sanfilippo F, et al. ; SPARTAN Collaborative (Small Projects, Audits and Research Projects-Australia/New Zealand): Criteria, processes, and determination of competence in basic critical care echocardiography training: A Delphi process consensus statement by the learning ultrasound in critical care (LUCC) initiative. Chest. 161: 492–503, 2022. PubMed

Jing Y, Yuan Z, Zhou W, et al. : A phased intervention bundle to decrease the mortality of patients with extracorporeal membrane oxygenation in intensive care unit. Front Med (Lausanne). 9: 1005162, 2022. PubMed PMC

Nowak-Machen M, Schmid E, Schlensak C, et al. : Safety of transesophageal echocardiography during extracorporeal life support. Perfusion. 31: 634–639, 2016. PubMed

Morales Castro D, Abdelnour-Berchtold E, Urner M, et al. : Transesophageal echocardiography-guided extracorporeal membrane oxygenation cannulation in COVID-19 patients. J Cardiothorac Vasc Anesth. 36: 4296–4304, 2022. PubMed PMC

Lashin H, Shepherd S, Smith A: Contrast-enhanced echocardiography application in patients supported by extracorporeal membrane oxygenation (ECMO): A narrative review. J Cardiothorac Vasc Anesth. 36: 2080–2089, 2022. PubMed

Douflé G, Dragoi L, Morales Castro D, et al. : Head-to-toe bedside ultrasound for adult patients on extracorporeal membrane oxygenation. Intensive Care Med. 50: 632–645, 2024. PubMed

Lang RM, Badano LP, Mor-Avi V, et al. : Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 28: 1–39.e14, 2015. PubMed

Rudski LG, Lai WW, Afilalo J, et al. : Guidelines for the echocardiographic assessment of the right heart in adults: A report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 23: 685–713; quiz 786, 2010. PubMed

Koestenberger M, Ravekes W, Everett AD, et al. : Right ventricular function in infants, children and adolescents: Reference values of the tricuspid annular plane systolic excursion (TAPSE) in 640 healthy patients and calculation of z score values. J Am Soc Echocardiogr. 22: 715–719, 2009. PubMed

Lammers AE, Apitz C, Michel-Behnke I, Koestenberger M: A guide to echocardiographic assessment in children and adolescents with pulmonary hypertension. Cardiovasc Diagn Ther. 11: 1160–1177, 2021. PubMed PMC

Lai WW, Geva T, Shirali GS, et al. ; Task Force of the Pediatric Council of the American Society of Echocardiography: Guidelines and standards for performance of a pediatric echocardiogram: A report from the Task Force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr. 19: 1413–1430, 2006. PubMed

Pettersen MD, Du W, Skeens ME, Humes RA: Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: An echocardiographic study. J Am Soc Echocardiogr. 21: 922–934, 2008. PubMed

Koestenberger M, Nagel B, Ravekes W, et al. : Reference values of tricuspid annular peak systolic velocity in healthy pediatric patients, calculation of z score, and comparison to tricuspid annular plane systolic excursion. Am J Cardiol. 109: 116–121, 2012. PubMed

Lopez L, Saurers DL, Barker PCA, et al. : Guidelines for performing a comprehensive pediatric transthoracic echocardiogram: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 37: 119–170, 2024. PubMed

Lemor A, Basir MB, O’Neill BP, et al. : Left atrial-veno-arterial extracorporeal membrane oxygenation: Step-by-step procedure and case example. Struct Heart. 6: 100117, 2022. PubMed PMC

Golzarian H, Thiel A, Hempfling G, et al. : Severe aortic insufficiency-induced cardiogenic shock treated with left atrial VA-ECMO and emergent valve-in-valve TAVR. ESC Heart Fail. 10: 3718–3724, 2023. PubMed PMC

Huang S, Vignon P, Mekontso-Dessap A, et al. : Echocardiography findings in COVID-19 patients admitted to intensive care units: A multi-national observational study (the ECHO-COVID study). Intensive Care Med. 48: 667–678, 2022. PubMed PMC

Reis Miranda D, van Thiel R, Brodie D, Bakker J: Right ventricular unloading after initiation of venovenous extracorporeal membrane oxygenation. Am J Respir Crit Care Med. 191: 346–348, 2015. PubMed

Levy D, Desnos C, Lebreton G, et al. : Early reversal of right ventricular dysfunction after venovenous extracorporeal membrane oxygenation in patients with COVID-19 pneumonia. Am J Respir Crit Care Med. 207: 784–787, 2023. PubMed PMC

Kon ZN, Bittle GJ, Pasrija C, et al. : Venovenous versus venoarterial extracorporeal membrane oxygenation for adult patients with acute respiratory distress syndrome requiring precannulation hemodynamic support: A review of the ELSO registry. Ann Thorac Surg. 104: 645–649, 2017. PubMed

Jaber B, Bembea MM, Loftis LL, et al. ; the Pediatric ECMO (PediECMO) Subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network and the Extracorporeal Life Support Organization (ELSO): Venovenous versus venoarterial extracorporeal membranous oxygenation in inotrope dependent pediatric patients with respiratory failure. ASAIO J. 67: 457–462, 2021. PubMed

Furlong-Dillard JM, Feygin YB, Reeder RW, et al. : Comparing outcomes of venovenous versus venoarterial extracorporeal membrane oxygenation in neonatal and pediatric respiratory failure: A retrospective review of Extracorporeal Life Support Organization registry. J Ped Crit Care. 10: 205–212, 2023.

Rais-Bahrami K, Van Meurs KP: Venoarterial versus venovenous ECMO for neonatal respiratory failure. Semin Perinatol. 38: 71–77, 2014. PubMed

Bagate F, Masi P, Boukantar M, et al. : Refractory cor pulmonale under extracorporeal membrane oxygenation for acute respiratory distress syndrome: The role of conversion to veno-pulmonary arterial assist—a case series. Front Med. 11: 1348077, 2024. PubMed PMC

Vieillard-Baron A, Prin S, Chergui K, Dubourg O, Jardin F: Echo-Doppler demonstration of acute cor pulmonale at the bedside in the medical intensive care unit. Am J Respir Crit Care Med. 166: 1310–1319, 2002. PubMed

Lorusso R, Shekar K, MacLaren G, et al. : ELSO interim guidelines for venoarterial extracorporeal membrane oxygenation in adult cardiac patients. ASAIO J. 67: 827–844, 2021. PubMed

Hussey PT, von Mering G, Nanda NC, Ahmed MI, Addis DR: Echocardiography for extracorporeal membrane oxygenation. Echocardiogr. 39: 339–370, 2022. PubMed PMC

Donker DW, Meuwese CL, Braithwaite SA, et al. : Echocardiography in extracorporeal life support: A key player in procedural guidance, tailoring and monitoring. Perfusion. 33(1_suppl): 31–41, 2018. PubMed

Ko UW, Choi CH, Park CH, Lee SI: Alternative position of cannulae in veno-venous extracorporeal membrane oxygenation for maintaining sufficient flow support. Gen Thorac Cardiovasc Surg. 71: 369–372, 2023. PubMed

Falk L, Sallisalmi M, Lindholm JA, et al. : Differential hypoxemia during venoarterial extracorporeal membrane oxygenation. Perfusion. 34: 22–29, 2019. PubMed

Bidar F, Lancelot A, Lebreton G, et al. : Venous or arterial thromboses after venoarterial extracorporeal membrane oxygenation support: Frequency and risk factors. J Heart Lung Transplant. 40: 307–315, 2021. PubMed

Kipfmueller F, Bo B, Schmitt J, et al. : Percutaneous, ultrasound-guided single- and multisite cannulation for veno-venous extracorporeal membrane oxygenation in neonates. Pediatr Pulmonol. 58: 2574–2582, 2023. PubMed

Salazar PA, Blitzer D, Dolejs SC, Parent JJ, Gray BW: Echocardiographic guidance during neonatal and pediatric jugular cannulation for ECMO. J Surg Res. 232: 517–523, 2018. PubMed

Frenckner B, Broman M, Broomé M: Position of draining venous cannula in extracorporeal membrane oxygenation for respiratory and respiratory/circulatory support in adult patients. Crit Care. 22: 163, 2018. PubMed PMC

The Alfred ICU: ECMO.icu; December 15, 2021. Available at: https://ecmoicu/procedures-percutaneous-ecmo-cannulation/ Accessed November 11, 2025

Tabak B, Elliott CL, Mahnke CB, Tanaka LY, Ogino MT: Transthoracic echocardiography visualization of bicaval dual lumen catheters for veno-venous extracorporeal membrane oxygenation. J Clin Ultrasound. 40: 183–186, 2012. PubMed

Pineton de Chambrun M, Combes A, Hekimian G: Contrast-enhanced Doppler echography to assess position of the distal leg perfusion line in patients on venoarterial extracorporeal membrane oxygenation: A preliminary study. Artif Organs. 43: 605–606, 2019. PubMed

Speggiorin S, Robinson S, Harvey C, et al. : Experience with the Avalon® bicaval double-lumen veno-venous cannula for neonatal respiratory ECMO. Perfusion. 30: 250–254, 2015. PubMed

Jarboe MD, Gadepalli SK, Church JT, Arnold MA, Hirschl RB, Mychaliska GB: Avalon catheters in pediatric patients requiring ECMO: Placement and migration problems. J Pediatr Surg. 53: 159–162, 2018. PubMed

Körver EP, Ganushchak YM, Simons AP, Donker DW, Maessen JG, Weerwind PW: Quantification of recirculation as an adjuvant to transthoracic echocardiography for optimization of dual-lumen extracorporeal life support. Intensive Care Med. 38: 906–909, 2012. PubMed PMC

Clements D, Primmer J, Ryman P, Marr B, Searles B, Darling E: Measurements of recirculation during neonatal veno-venous extracorporeal membrane oxygenation: Clinical application of the ultrasound dilution technique. J Extra Corpor Technol. 40: 184–187, 2008. PubMed PMC

Buchtele N, Staudinger T, Schwameis M, Schörgenhofer C, Herkner H, Hermann A; UltraECMO investigators: Feasibility and safety of watershed detection by contrast-enhanced ultrasound in patients receiving peripheral venoarterial extracorporeal membrane oxygenation: A prospective observational study. Crit Care. 24: 126, 2020. PubMed PMC

Aissaoui N, Luyt CE, Leprince P, et al. : Predictors of successful extracorporeal membrane oxygenation (ECMO) weaning after assistance for refractory cardiogenic shock. Intensive Care Med. 37: 1738–1745, 2011. PubMed

Punn R, Axelrod DM, Sherman-Levine S, Roth SJ, Tacy TA: Predictors of mortality in pediatric patients on venoarterial extracorporeal membrane oxygenation. Pediatr Crit Care Med. 15: 870–877, 2014. PubMed PMC

Punn R, Falkensammer CB, Blinder JJ, et al. : Hemodynamic and echocardiographic predictors of mortality in pediatric patients on venoarterial extracorporeal membrane oxygenation: A multicenter investigation. J Am Soc Echocardiogr. 36: 233–241, 2023. PubMed

Kim D, Jang WJ, Park TK, et al. : Echocardiographic predictors of successful extracorporeal membrane oxygenation weaning after refractory cardiogenic shock. J Am Soc Echocardiogr. 34: 414–422.e4, 2021. PubMed

Huang KC, Lin LY, Chen YS, Lai CH, Hwang JJ, Lin LC: Three-dimensional echocardiography-derived right ventricular ejection fraction correlates with success of decannulation and prognosis in patients stabilized by venoarterial extracorporeal life support. J Am Soc Echocardiogr. 31: 169–179, 2018. PubMed

Aissaoui N, Caudron J, Leprince P, et al. : Right-left ventricular interdependence: A promising predictor of successful extracorporeal membrane oxygenation (ECMO) weaning after assistance for refractory cardiogenic shock. Intensive Care Med. 43: 592–594, 2017. PubMed

Aissaoui N, Guerot E, Combes A, et al. : Two-dimensional strain rate and Doppler tissue myocardial velocities: Analysis by echocardiography of hemodynamic and functional changes of the failed left ventricle during different degrees of extracorporeal life support. J Am Soc Echocardiogr. 25: 632–640, 2012. PubMed

Kim D, Park Y, Choi KH, et al. : Prognostic implication of RV coupling to pulmonary circulation for successful weaning from extracorporeal membrane oxygenation. JACC Cardiovasc Imaging. 14: 1523–1531, 2021. PubMed

Ng PY, Ma TSK, Ip A, et al. : Effects of varying blood flow rate during peripheral veno-arterial extracorporeal membrane oxygen (V-A ECMO) on left ventricular function measured by two-dimensional strain. Front Cardiovasc Med. 10: 1147783, 2023. PubMed PMC

Ng PY, Ma TSK, Ip A, et al. : Sensitivity of ventricular systolic function to afterload during veno-arterial extracorporeal membrane oxygenation. ESC Heart Fail. 9: 3241–3253, 2022. PubMed PMC

Sawamura A, Okumura T, Hirakawa A, et al. ; CHANGE PUMP Investigators: Early prediction model for successful bridge to recovery in patients with fulminant myocarditis supported with percutaneous venoarterial extracorporeal membrane oxygenation—insights from the CHANGE PUMP study. Circ J. 82: 699–707, 2018. PubMed

Sawada K, Kawakami S, Murata S, et al. : Predicting parameters for successful weaning from veno-arterial extracorporeal membrane oxygenation in cardiogenic shock. ESC Heart Fail. 8: 471–480, 2021. PubMed PMC

Ostadal P, Vondrakova D, Popkova M, et al. : Aortic stenosis and mitral regurgitation modify the effect of venoarterial extracorporeal membrane oxygenation on left ventricular function in cardiogenic shock. Sci Rep. 12: 17076, 2022. PubMed PMC

Villablanca P, Nona P, Lemor A, et al. : Mechanical circulatory support in cardiogenic shock due to structural heart disease. Interv Cardiol Clin. 10: 221–234, 2021. PubMed

Schrage B, Sundermeyer J, Blankenberg S, et al. : Timing of active left ventricular unloading in patients on venoarterial extracorporeal membrane oxygenation therapy. JACC Heart Fail. 11: 321–330, 2023. PubMed

Møller JE, Engstrøm T, Jensen LO, et al. ; DanGer Shock Investigators: Microaxial flow pump or standard care in infarct-related cardiogenic shock. N Engl J Med. 390: 1382–1393, 2024. PubMed

Belohlavek J, Hunziker P, Donker DW: Left ventricular unloading and the role of ECpella. Eur Heart J Suppl. 23(Suppl A): A27–A34, 2021. PubMed PMC

Ezad SM, Ryan M, Donker DW, et al. : Unloading the left ventricle in venoarterial ECMO: In whom, when, and how? Circulation. 147: 1237–1250, 2023. PubMed PMC

Tavazzi G, Alviar CL, Colombo CNJ, Dammassa V, Price S, Vandenbriele C: How to unload the left ventricle during veno-arterial extracorporeal membrane oxygenation. Eur Heart J Cardiovasc Imaging. 24: 696–698, 2023. PubMed

Tavazzi G, Price S, Beitnes JO, et al. : Imaging in acute percutaneous mechanical circulatory support in adults: A clinical consensus statement of the Association for Acute CardioVascular Care (ACVC) of the ESC, the European Association of Cardiovascular Imaging (EACVI) of the ESC and the European branch of the Extracorporeal Life Support Organization (EuroELSO). Eur Heart J Cardiovasc Imaging. 25: e296–e311, 2024. PubMed

Price S, Platz E, Cullen L, et al. : Expert consensus document: Echocardiography and lung ultrasonography for the assessment and management of acute heart failure. Nat Rev Cardiol. 14: 427–440, 2017. doi:10.1038/nrcardio.2017.56. PubMed PMC

Cevasco M, Takayama H, Ando M, Garan AR, Naka Y, Takeda K: Left ventricular distension and venting strategies for patients on venoarterial extracorporeal membrane oxygenation. J Thorac Dis. 11: 1676–1683, 2019. PubMed PMC

Zochios V, Nasa P, Yusuff H, et al. ; on behalf of the RVI-ECMO Delphi Expert group: Definition and management of right ventricular injury in adult patients receiving extracorporeal membrane oxygenation for respiratory support using the Delphi method: A PRORVnet study. Expert position statements. Intensive Care Med. 50: 1411–1425, 2024. PubMed PMC

Fiedler AG, Dalia A, Axtell AL, et al. : Impella placement guided by echocardiography can be used as a strategy to unload the left ventricle during peripheral venoarterial extracorporeal membrane oxygenation. J Cardiothorac Vasc Anesth. 32: 2585–2591, 2018. PubMed

Anand S, Barry T, Arsanjani R, LeMond L: Echocardiography in cardiac assist devices. Rev Cardiovasc Med. 23: 253, 2022. PubMed PMC

Montisci A, Bertoldi LF, Price S, Hassager C, Moller J, Pappalardo F: Intensive care unit management of percutaneous mechanical circulatory supported patients: The role of imaging. Eur Heart J Suppl. 23(Suppl A): A15–A22, 2021. PubMed PMC

Shimada S, Nawata K, Kinoshita O, Ono M: Mechanical circulatory support for the right ventricle in combination with a left ventricular assist device. Expert Rev Med Devices. 16: 663–673, 2019. PubMed

Estep JD, Nicoara A, Cavalcante J, et al. : Recommendations for multimodality imaging of patients with left ventricular assist devices and temporary mechanical support: Updated recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 37: 820–871, 2024. PubMed

Isha S, Narra SA, Batool H, et al. : Assessing right ventricle over time in patients on veno-venous extracorporeal membrane oxygenation: insights from serial echocardiography. ASAIO J. 70: 1033–1039, 2024. PubMed

Morales Castro D, Ferreyro BL, McAlpine D, et al. : Echocardiographic findings in critically ill COVID-19 patients treated with and without extracorporeal membrane oxygenation. J Cardiothorac Vasc Anesth. 38: 3043–3054, 2024. PubMed

Tonna JE, Abrams D, Brodie D, et al. : Management of adult patients supported with venovenous extracorporeal membrane oxygenation (VV ECMO): Guideline from the Extracorporeal Life Support Organization (ELSO). ASAIO J. 67: 601–610, 2021. PubMed PMC

Martin-Villen L, Martin-Bermudez R, Perez-Chomon H, Fuset Cabanes MP: Role of ultrasound in the critical ill patient with ECMO. Med Intensiva (Engl Ed). 48: 46–55, 2024. PubMed

Basílio C, Anders M, Rycus P, Paiva JA, Roncon-Albuquerque R: Cardiac tamponade complicating extracorporeal membrane oxygenation: An extracorporeal life support organization registry analysis. J Cardiothorac Vasc Anesth. 38: 731–738, 2023. PubMed

Seelhammer TG, Loftsgard TO, Wittwer ED, Ritter MJ: Cardiac tamponade in a patient supported by veno-arterial extracorporeal membrane oxygenation. Ann Card Anaesth. 25: 204–205, 2022. PubMed PMC

Dragoi L, Teijeiro-Paradis R, Douflé G: When is tamponade not an echocardiographic diagnosis... Or is it ever? Echocardiogr. 39: 880–885, 2022. PubMed

Combes A, Leprince P, Luyt CE, et al. : Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med. 36: 1404–1411, 2008. PubMed

Iannattone PA, Yang SS, Koolian M, Wong EG, Lipes J: Incidence of venous thromboembolism in adults receiving extracorporeal membrane oxygenation: A systematic review. ASAIO J. 68: 1523–1528, 2022. PubMed

Abruzzo A, Gorantla V, Thomas SE: Venous thromboembolic events in the setting of extracorporeal membrane oxygenation support in adults: A systematic review. Thromb Res. 212: 58–71, 2022. PubMed

Fanning JP, Weaver N, Fanning RB, et al. ; COVID-19 Critical Care Consortium: Hemorrhage, disseminated intravascular coagulopathy, and thrombosis complications among critically ill patients with COVID-19: An international COVID-19 critical care consortium study. Crit Care Med. 51: 619–631, 2023. PubMed PMC

Kohs TCL, Weeder BR, Chobrutskiy BI, et al. : Predictors of thrombosis during VV ECMO: An analysis of 9809 patients from the ELSO registry. J Thromb Thrombolysis. 57: 345–351, 2024. PubMed PMC

Miksova L, Dytrych V, Ptacnik V, et al. : Pulmonary perfusion in long-term survivors of COVID-19-related severe acute respiratory distress syndrome treated by extracorporeal membrane oxygenation. Pulm Circ. 14: e12431, 2024. PubMed PMC

Simons J, Di Mauro M, Mariani S, et al. : Bilateral femoral cannulation is associated with reduced severe limb ischemia-related complications compared with unilateral femoral cannulation in adult peripheral venoarterial extracorporeal membrane oxygenation: Results from the extracorporeal life support registry. Crit Care Med. 52: 80–91, 2024. PubMed

Sun G, Huang S, Zhang G, Zhang Z, Wang B: Outcomes comparison between percutaneous decannulation with perclose ProGlide and surgical decannulation of veno-arterial extracorporeal membrane oxygenation. Perfusion. 8: 2676591231194761, 2023. doi:10.1177/02676591231194761. PubMed

Balik M, Maly M, Huptych M, Mokotedi MC, Lambert L: Prognostic impact of serial imaging in severe acute respiratory distress syndrome on the extracorporeal membrane oxygenation. J Clin Med. 12: 6367, 2023. PubMed PMC

Bouhemad B, Brisson H, Le-Guen M, Arbelot C, Lu Q, Rouby JJ: Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med. 183: 341–347, 2011. PubMed

Mongodi S, Bouhemad B, Orlando A, et al. : Modified lung ultrasound score for assessing and monitoring pulmonary aeration. Ultraschall Med. 38: 530–537, 2017. PubMed

Zhang Y, Xue H, Wang M, He N, Lv Z, Cui L: Lung ultrasound findings in patients with coronavirus disease (COVID-19). AJR Am J Roentgenol. 216: 80–84, 2021. PubMed

Yang Y, Huang Y, Gao F, Yuan L, Wang Z: Lung ultrasonography versus chest CT in COVID-19 pneumonia: A two-centered retrospective comparison study from China. Intensive Care Med. 46: 1761–1763, 2020. PubMed PMC

Goligher EC, Leis JA, Fowler RA, Pinto R, Adhikari NK, Ferguson ND: Utility and safety of draining pleural effusions in mechanically ventilated patients: A systematic review and meta-analysis. Crit Care. 15: R46, 2011. PubMed PMC

Balik M, Mokotedi MC, Maly M, et al. : Pulmonary consolidation alters the ultrasound estimate of pleural fluid volume when considering chest drainage in patients on ECMO. Crit Care. 26: 144, 2022. PubMed PMC

Balik M, Plasil P, Waldauf P, et al. : Ultrasound estimation of volume of pleural fluid in mechanically ventilated patients. Intensive Care Med. 32: 318, 2006. PubMed

Bedawi EO, Talwar A, Hassan M, et al. : Intercostal vessel screening prior to pleural interventions by the respiratory physician: A prospective study of real world practice. Eur Respir J. 55: 1902245, 2020. PubMed

Balik M, Svobodova E, Porizka M, et al. : The impact of obesity on the outcome of severe SARS-CoV-2 ARDS in a high volume ECMO centre: ECMO and corticosteroids support the obesity paradox. J Crit Care. 72: 154162, 2022. PubMed PMC

Maly M, Mokotedi MC, Svobodova E, et al. : Interpleural location of chest drain on ultrasound excludes pneumothorax and associates with a low degree of chest drain foreshortening on the antero-posterior chest X-ray. Ultrasound J. 14: 45, 2022. PubMed PMC

Lichtenstein D, Mezière G, Biderman P, Gepner A: The “lung point”: An ultrasound sign specific to pneumothorax. Intensive Care Med. 26: 1434–1440, 2000. PubMed

Mokotedi MC, Lambert L, Simakova L, et al. : X-ray indices of chest drain malposition after insertion for drainage of pneumothorax in mechanically ventilated critically ill patients. J Thorac Dis. 10: 5695–5701, 2018. PubMed PMC

Curry S, Tan A, Gargani L, et al. : Lung ultrasound and the role of lung aeration score in patients with acute respiratory distress syndrome on extracorporeal membrane oxygenation. Int J Artif Organs. 44: 854–860, 2021. PubMed

Moller-Sorensen H, Gjedsted J, Lind Jorgensen V, Lindskov Hansen K: COVID-19 assessment with bedside lung ultrasound in a population of intensive care patients treated with mechanical ventilation and ECMO. Diagnostics (Basel). 10: 447, 2020. PubMed PMC

Mongodi S, Pozzi M, Orlando A, et al. : Lung ultrasound for daily monitoring of ARDS patients on extracorporeal membrane oxygenation: Preliminary experience. Intensive Care Med. 44: 123–124, 2018. PubMed

Pasqueron J, Dureau P, Arcile G, et al. : Usefulness of lung ultrasound for early detection of hospital-acquired pneumonia in cardiac critically ill patients on venoarterial extracorporeal membrane oxygenation. Annals of Intensive Care. 12: null, 2022. doi:10.1186/s13613-022-01013-9. PubMed PMC

O’Brien NF, Reuter-Rice K, Wainwright MS, et al. : Practice recommendations for transcranial Doppler ultrasonography in critically ill children in the pediatric intensive care unit: A multidisciplinary expert consensus statement. J Pediatr Intensive Care. 10: 133–142, 2021. PubMed PMC

McCutcheon KC, Wise L, Lewis K, Gilbert B, Bhatia J, Stansfield BK: The utility of cranial ultrasound as a screening tool for neonatal ECMO. J Perinat Med. 48: 173–178, 2020. PubMed

Bianzina S, Singh Y, Iacobelli R, Amodeo A, Guner Y, Di Nardo M: Use of point-of-care ultrasound (POCUS) to monitor neonatal and pediatric extracorporeal life support. Eur J Pediatr. 183: 1509–1524, 2024. PubMed

Aboul-Nour H, Jumah A, Abdulla H, et al. : Neurological monitoring in ECMO patients: Current state of practice, challenges and lessons. Acta Neurol Belg. 123: 341–350, 2023. PubMed PMC

Polito A, Barrett CS, Wypij D, et al. : Neurologic complications in neonates supported with extracorporeal membrane oxygenation. An analysis of ELSO registry data. Intensive Care Med. 39: 1594–1601, 2013. PubMed

Cho SM, Hwang J, Chiarini G, et al. : Neurological monitoring and management for adult extracorporeal membrane oxygenation patients: Extracorporeal life support organization consensus guidelines. Crit Care. 28: 296, 2024. PubMed PMC

Cho SM, Farrokh S, Whitman G, Bleck TP, Geocadin RG: Neurocritical care for extracorporeal membrane oxygenation patients. Crit Care Med. 47: 1773–1781, 2019. PubMed

Caturegli G, Choi CW, Geocadin R, Whitman G, Cho SM, Ziai W: Cerebral hemodynamics with TCD in ECMO. Crit Care Med. 50: 368, 2022. doi:10.1097/01.ccm.0000809316.17322.1a.

Caturegli G, Kapoor S, Ponomarev V, et al. ; HERALD (Hopkins Exploration, Research, and Advancement in Life Support Devices) Investigators: Transcranial Doppler microemboli and acute brain injury in extracorporeal membrane oxygenation: A prospective observational study. JTCVS Tech. 15: 111–122, 2022. PubMed PMC

Rivas-Rangel J, Garcia-Arellano M, Marquez-Romero JM: Correlation between optic nerve sheath diameter and extracorporeal life support time. An Pediatr (Engl Ed). 96: 91–96, 2022. PubMed

Cannata G, Pezzato S, Esposito S, Moscatelli A: Optic nerve sheath diameter ultrasound: A non-invasive approach to evaluate increased intracranial pressure in critically ill pediatric patients. Diagnostics (Basel). 12: 767, 2022. PubMed PMC

Cestari M, Gobatto ALN, Hoshino M: Role and limitations of transcranial Doppler and brain death of patients on veno-arterial extracorporeal membrane oxygenation. ASAIO J. 64: e78, 2018. PubMed

Berthoud V, Ellouze O, Constandache T, Martin A, Bouhemad B, Guinot PG: Transcranial doppler waveform patterns in nonpulsatile blood flow under venoarterial extracorporeal membrane oxygenation for brain death diagnosis. ASAIO J. 66: e64, 2020. PubMed

Marinoni M, Cianchi G, Trapani S, et al. : Retrospective analysis of transcranial Doppler patterns in veno-arterial extracorporeal membrane oxygenation patients: Feasibility of cerebral circulatory arrest diagnosis. ASAIO J. 64: 175–182, 2018. PubMed

Balik M, Waldauf P, Maly M, et al. : Echocardiography predictors of sustained sinus rhythm after cardioversion of supraventricular arrhythmia in patients with septic shock. J Crit Care. 83: 154832, 2024. PubMed

Gillon SA, Barrett NA, Ioannou N, et al. : Intracardiac right-to-left shunt impeding liberation from veno-venous extracorporeal membrane oxygenation: Two case studies. Crit Care Med. 44: e583–e586, 2016. PubMed

Bautista-Rodriguez C, Sanchez-de-Toledo J, Da Cruz EM: The role of echocardiography in neonates and pediatric patients on extracorporeal membrane oxygenation. Front Pediatr. 6: 297, 2018. PubMed PMC

Aissaoui N, El-Banayosy A, Combes A: How to wean a patient from veno-arterial extracorporeal membrane oxygenation. Intensive Care Med. 41: 902–905, 2015. PubMed

Pappalardo F, Pieri M, Arnaez Corada B, et al. : Timing and strategy for weaning from venoarterial ECMO are complex issues. J Cardiothorac Vasc Anesth. 29: 906–911, 2015. PubMed

Charbonneau F, Chahinian K, Bebawi E, et al. : Parameters associated with successful weaning of veno-arterial extracorporeal membrane oxygenation: A systematic review. Crit Care. 26: 375, 2022. PubMed PMC

Douflé G, Roscoe A, Billia F, Fan E: Echocardiography for adult patients supported with extracorporeal membrane oxygenation. Crit Care. 19: 326, 2015. PubMed PMC

Cavarocchi NC, Pitcher HT, Yang Q, et al. : Weaning of extracorporeal membrane oxygenation using continuous hemodynamic transesophageal echocardiography. J Thorac Cardiovasc Surg. 146: 1474–1479, 2013. PubMed

Bartko PE, Wiedemann D, Schrutka L, et al. : Impact of right ventricular performance in patients undergoing extracorporeal membrane oxygenation following cardiac surgery. J Am Heart Assoc. 6: e005455, 2017. PubMed PMC

Huang KC, Lin LY, Chen YS, Lai CH, Hwang JJ, Lin LC: Three-dimensional echocardiography-derived right ventricular ejection fraction correlates with success of decannulation and prognosis in patients stabilized by venoarterial extracorporeal life support. J Am Soc Echocardiogr. 31: 169–179, 2017. doi:10.1016/j.echo.2017.09.004. PubMed

Westrope C, Harvey C, Robinson S, Speggiorin S, Faulkner G, Peek GJ: Pump controlled retrograde trial off from VA-ECMO. ASAIO J. 59: 517–519, 2013. PubMed