Diehl Arne, Coughlin Benjamin, Moriarty Heather, Joseph Timothy, Kavnoudias Helen, Udy Andrew
From the Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
ASAIO J. 2024 Dec 1;70(12):e182-e187. doi: 10.1097/MAT.0000000000002220. Epub 2024 May 6.
Veno-arterial extracorporeal membrane oxygenation (VA ECMO) fundamentally alters patient physiology and blood flow relevant to contrast delivery for computed tomography (CT) imaging. Here, we present a comprehensive guide to contrast-enhanced CT scanning in adult ECMO patients, addressing common questions related to contrast delivery via the ECMO circuit, and modifications to ECMO settings and scanning techniques, to avoid non-diagnostic CT scans. The approach is described in detail for patients supported on VA ECMO, with the return cannula sited in the femoral artery. Lesser modifications required for veno-venous ECMO (VV ECMO) are included in the supplemental material. Establishing a common understanding between the intensive care clinician, the CT radiographer, and the radiologist, concerning the patient's blood-flow-physiology, is the overarching goal. Our stepwise approach facilitates clear communication around modifications to the ECMO pump settings, contrast route and rate, as well as the scanning technique, for each individual scenario.
静脉-动脉体外膜肺氧合（VA ECMO）从根本上改变了与计算机断层扫描（CT）成像造影剂输送相关的患者生理状态和血流情况。在此，我们为成年ECMO患者的增强CT扫描提供一份全面指南，解决与通过ECMO回路输送造影剂相关的常见问题，以及对ECMO设置和扫描技术的调整，以避免CT扫描结果无法诊断。本文详细描述了股动脉置有回血插管的VA ECMO支持患者的扫描方法，补充材料中包含了静脉-静脉ECMO（VV ECMO）所需的较小调整。重症监护临床医生、CT放射技师和放射科医生就患者的血流生理状况达成共识是首要目标。我们的逐步方法有助于针对每种具体情况，围绕ECMO泵设置、造影剂路径和速率以及扫描技术的调整进行清晰沟通。
