Role of Ultrasound for Management of Critical Severe COVID-19 Patients with ECMO

doi:10.37015/AUDT.2020.200033

Abstract

Abstract:

Objective: To evaluate the role of ultrasound in the use and maintenance of ECMO for COVID-19 cases.
Methods: During the outbreak of COVID-19 in China, three critically ill patients were treated with ECMO in our hospital. Bedside ultrasound was used throughout all procedures, including in the delivery and daily monitoring of ECMO.
Results: Structural and functional changes of heart, pleural effusion, as well as thrombus formation in one patient’s right atrium were noted with ultrasonography. Using bedside ultrasound as a troubleshooting tool throughout ECMO therapy provided a lot of useful and reliable real-time information to assist clinical decision making.
Conclusion: Ultrasound shall play an important role in the use and maintenance of ECMO for COVID-19 cases.

Key words: Ultrasound; Extra Corporeal Membrane Oxygenation; Acute respiratory distress syndrome; Thrombosis; COVID-19

Shunji Gao, MD, Liuqiong Ren, MD, Wenhong Gao, MD, Qun’an Huang, MD, Shengzheng Wu, MD, Jianqiu Hu, MD, Yuejuan Gao, MD, Faqin Lv, MD, Huijuan Xiang, MD. Role of Ultrasound for Management of Critical Severe COVID-19 Patients with ECMO. Advanced Ultrasound in Diagnosis and Therapy, 2020, 4(2): 134-137.

References

[1]	China National Health Commission. Chinese clinical guidance for covid-19 pneumonia diagnosis and treatment (trial, 7th edition), 2020, March 4. [In Chinese] Available from: http://www.nhc.gov.cn/yzygj/s7652m/202003/a31191442e29474b98bfed5579d5af95.shtml.
[2]	Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020 Feb 28: NEJMoa2002032. DOI: 10.1056/NEJMoa2002032.
[3]	Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020 Feb 7:e201585. DOI: 10.1001/jama.2020.1585.
[4]	Chan KW, Wong VT, Tang SCW. COVID-19: an update on the epidemiological, clinical, preventive and therapeutic evidence and guidelines of integrative chinese-western medicine for the management of 2019 novel coronavirus disease. Am J Chin Med. 2020 Mar 13: 1-26. DOI: 10.1142/S0192415X20500378.
[5]	Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: The Berlin Definition. JAMA 2012, 307:2526-2533.
[6]	Chinese Thoracic Society, Chinese Association of Chest Physicians. Guide for the prevention and treatment of coronavirus disease 2019. Chin J Tuberc Respir Dis. 2020; 43. [In Chinese] Available from:http://rs.yiigle.com/yufabiao/1187175.htm.
[7]	Platts DG, Sedgwick JF, Burstow DJ, Mullany DV, Fraser JF. The role of echocardiography in the management of patients supported by extracorporeal membrane oxygenation. J Am Soc Echocardiogr 2012; 25:131-141.
[8]	Morris AH, Wallace CJ, Menlove RL, Clemmer TP, Orme JF Jr, Weaver LK, et al. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med 1994; 149:295-305.
[9]	Combes A, Hajage D, Capellier G, Demoule A, Lavoué S, Guervilly C, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med 2018, 378:1965-1975.
[10]	Bosarge PL, Raff LA, McGwin G Jr, Carroll SL, Bellot SC, Diaz-Guzman E, et al. Early initiation of extracorporeal membrane oxygenation improves survival in adult trauma patients with severe adult respiratory distress syndrome. J Trauma Acute Care Surg 2016; 81:236-243.
[11]	Mattar A, Chatterjee S, Loor G. Bridging to lung transplantation. Crit Care Clin 2019; 35:11-25.
[12]	Makhoul M, Bitton-Worms K, Adler Z, Saeed A, Cohen O, Bolotin G. Extracorporeal membrane oxygenation (ECMO)-a lifesaving technology. Review and single-center experience. Rambam Maimonides Med J 2019; 10:e0013.
[13]	Thiagarajan RR, Barbaro RP, Rycus PT, Mcmullan DM, Conrad SA, Fortenberry JD, et al. Extracorporeal life support organization registry international report 2016. ASAIO J 2017; 63:60-67.

[1]	Liu Taixia, Wang Hanxiang, Wang Dan, Zhang Yuke, Guo Yunyun, Liu Shuo, Zhang Minfeng, Nie Hongming, Shen Rui. The Role of Sonazoid-contrast-enhanced Ultrasound In Precision Diagnosis and Guidance for Radiofrequency Ablation Therapy of Hepatocellular Carcinoma: a Literature Review [J]. Advanced Ultrasound in Diagnosis and Therapy, 2026, 10(1): 20-28.
[2]	Fu Lijia, Li Na, Liao Ziling, Lin Yanping, Li Zhaojun, Li Fan. Advances in Breast Ultrasound Segmentation and Classification [J]. Advanced Ultrasound in Diagnosis and Therapy, 2026, 10(1): 29-41.
[3]	Li Na, Li Fan. Focused Ultrasound Combined with Microbubbles for Inducing Blood-Brain Barrier Opening: Cavitation Monitoring and Control [J]. Advanced Ultrasound in Diagnosis and Therapy, 2026, 10(1): 51-58.
[4]	Yin Yulian, Cheng Yifan, Zhou Liangmei, Zhong Yuanyuan, Wang Bing, Wu Jingjing, Ren Yajuan, Gao Dongwen, Chen Hongfeng, Ye Meina, Yin Haoqiang. From Non-Mass Stage to Complex Type: Ultrasonographic Assessment of Granulomatous Lobular Mastitis Across Six Clinical Stages [J]. Advanced Ultrasound in Diagnosis and Therapy, 2026, 10(1): 59-68.
[5]	Syahril Erlin, Abdullah Nusratuddin, Ilyas Muhammad, As’ad Suryani, Choridah Lina, Natzir Rosdiana, Kurniawan Liong Boy, Bahar Burhanuddin, Mappaware Nasrudin A., Mulyadi Farah Ekawati, Yacca Susdiaman Sudin. The Effects of Ajwa Dates Consumption (Phoenix dactylifera L), on Ovarian Follicular Features with Transvaginal Ultrasound in Perimenopausal Women [J]. Advanced Ultrasound in Diagnosis and Therapy, 2026, 10(1): 69-73.
[6]	Si Jiahao, Zhang Ye, Wang Shuaiyanga, Hao Liuwei, Duan Shaobo. Ultrasound-Guided Portal Vein Puncture for The Treatment of Hepatic Portal Venous Gas: A Case Report [J]. Advanced Ultrasound in Diagnosis and Therapy, 2026, 10(1): 74-78.
[7]	Guan Xin, Hu Xinyuan, Han Hong, Zhang Dezhi, Xu Huixiong. The Evolving Application of Ultrasound in the Precision Management of Small Hepatocellular Carcinoma [J]. Advanced Ultrasound in Diagnosis and Therapy, 2025, 9(4): 375-387.
[8]	Li Yanran, Cui Yuanjie, Wu Qingqing, Zhang Na. Current Applications of Artificial Intelligence in Obstetric Ultrasound [J]. Advanced Ultrasound in Diagnosis and Therapy, 2025, 9(4): 449-456.
[9]	Hou Wenfei, Chen Wanting, Liu Huazhen, Tang Jiajia, Yang Meng. Applications of Ultrasound Localization Microscopy in Abdominal Imaging [J]. Advanced Ultrasound in Diagnosis and Therapy, 2025, 9(4): 347-356.
[10]	Yu Xiao jie, Song Zheng lai, Chang Xue yong, Yu Jie, Liang Ping. Artificial Intelligence in Ultrasound Diagnosis of Liver Nodules: A Comprehensive Review of B-Mode and Contrast-enhanced Applications [J]. Advanced Ultrasound in Diagnosis and Therapy, 2025, 9(4): 326-346.
[11]	Zhong Xian, Xie Xiaoyan. Multimodal Ultrasound Radiomics in Liver Disease: Current Status and Future Directions [J]. Advanced Ultrasound in Diagnosis and Therapy, 2025, 9(4): 388-408.
[12]	Zhang Xiaoqian, Zhang Jingwen, Dong Yijie, Zhou Jianqiao. Research Progress and Clinical Translation of Photoacoustic–ultrasound Fusion Imaging in Breast Cancer Diagnosis and Therapy [J]. Advanced Ultrasound in Diagnosis and Therapy, 2025, 9(4): 467-482.
[13]	Jin Tong, Yu Xiaohu, Ai Zheng, Guo Hongcheng. Artificial Intelligence in Ultrasound Imaging: A Review of Progress from Machine Learning to Large Language Model [J]. Advanced Ultrasound in Diagnosis and Therapy, 2025, 9(4): 483-496.
[14]	Xiang Xi, Yang Yujia, Wang Liyun, Qiu Li. Advances and Applications in Dermatological Ultrasound [J]. Advanced Ultrasound in Diagnosis and Therapy, 2025, 9(4): 457-466.
[15]	Zheng Hairong, Meng Long, Li Fei, Niu Lili, Qiu Weibao, Ma Teng, Liu Chengbo, Zhu Xuefeng, Wan Liwen, Cai Feiyan. Advance in Ultrasound Super-resolution Imaging, Cell Manipulation and Inter-brain Communication [J]. Advanced Ultrasound in Diagnosis and Therapy, 2025, 9(4): 307-325.