Point-of-Care Ultrasound-Guided Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Cannulation in Adult Patients

Xiong Lei; Lihua Sun; Boming Xia; Zhongheng Zhang

doi:10.3791/72871

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Method Article

Point-of-Care Ultrasound-Guided Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Cannulation in Adult Patients

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DOI:

10.3791/72871

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August 14th, 2026

Xiong Lei¹ , Lihua Sun² , Boming Xia¹ , Zhongheng Zhang¹^,³^,⁴^,⁵

¹Department of Emergency Medicine, Sir Run Run Shaw Hospital, ²Department of Ultrasound, Sir Run Run Shaw Hospital, ³Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Sir Run Run Shaw Hospital, ⁴School of Medicine, Shaoxing University, ⁵Key Laboratory of Emergency and Trauma of Ministry of Education, Engineering Research Center for Hainan Biological Sample Resources of Major Diseases

Summary

This protocol demonstrates the use of point-of-care ultrasound to guide peripheral veno-arterial extracorporeal membrane oxygenation cannulation through pre-procedural assessment, real-time procedural guidance, and post-cannulation verification.

Abstract

Point-of-care ultrasound (POCUS) has become an important imaging modality for guiding peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) cannulation. This protocol describes the integration of POCUS throughout the peripheral VA-ECMO cannulation workflow, including pre-procedural assessment, real-time procedural guidance, and post-cannulation verification. During the pre-procedural assessment, POCUS facilitates differentiation of arteries from veins, measurement of vessel diameter to estimate appropriate cannula size, and identification of vascular pathology, including plaques, thrombosis, and stenosis. During cannulation, combined out-of-plane and in-plane ultrasound techniques enable real-time visualization of the guidewire, confirmation of guidewire placement within the target vessel, and avoidance of posterior wall perforation or injury to adjacent structures. Following cannulation, POCUS is used to verify drainage cannula positioning at the inferior vena cava–right atrium junction and arterial return cannula positioning at the external or common iliac artery level, and to assess for complications such as cardiac tamponade, cannula malposition, and thrombosis. Compared with landmark-based or fluoroscopy-guided techniques, POCUS provides bedside imaging without ionizing radiation and supports continuous procedural guidance without interrupting resuscitation. This protocol provides a practical, evidence-based approach for ultrasound-guided peripheral VA-ECMO cannulation and focuses specifically on vascular access and cannulation rather than broader VA-ECMO management.

Introduction

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used as salvage therapy for patients with severe cardiogenic shock, refractory cardiac arrest, and profound cardiopulmonary failure¹^,². As the use of VA-ECMO has increased, the need for safe, rapid, and reliable cannulation techniques has also grown. Percutaneous cannulation using the Seldinger technique is commonly used for peripheral VA-ECMO because it avoids the morbidity associated with surgical cutdown and can be performed at the bedside³^,⁴. This method is intended specifically for ult....