Purpose or Case Report: BACKGROUND & OBJECTIVE: Extracorporeal Membrane Oxygenation (ECMO) is being used increasingly across the world as a short-term life support for infants, children, and adults. As of 2014, over 4500 patients at over 200 centers world-wide were being treated with ECMO annually. The applications of ECMO range from patients with acute cardiac or pulmonary failure, to patients who are immediately post-op from lung or heart transplant/surgery. In reading the daily batch of ICU radiographs, the pediatric radiologist will often see ECMO cannulae amongst the tubes and lines. Many radiologists can acknowledge the presence of cannulae, but are often unfamiliar with the radiographic details of cannulae position and complications. Our goal is to educate pediatric radiologists on ExtraCorporeal Membrane Oxygenation (ECMO) and the normal/abnormal appearance of radiographs of patients on ECMO.

Methods & Materials: METHODS: This retrospective study and pictorial review were approved by our institution’s Internal Review Board. The institution’s case list of all pediatric ECMO patients in the last 10 years was interrogated in order to find imaging examples of the different types of ECMO (venovenous and arteriovenous), the normal positions of these types of ECMO on radiographs, and imaging examples of ECMO complications or malpositioning. Optimal imaging examples were compiled for the review.
Results: RESULTS: This pictorial review will commence with a brief summary of ECMO function, types of ECMO, and how cannulae are placed. ECMO indications and applications will be outlined. There will be a short explanation of the medical treatments used specifically in ECMO patients as they pertain to imaging. Schematic diagrams, intraoperative photographs, and radiographs will be used to depict appropriate ECMO cannulae placement in children. The common complications of ECMO use and placement will be explained with additional case examples of ECMO malpositioning or common ECMO complications captured on imaging.
Conclusions: CONCLUSION: This pictorial review will familiarize the radiololgist with the principles, types, indications, and applications of ECMO in children, appropriate cannulae positioning based on ECMO type, and radiographic appearances of good position and malposition.