POCUS and Fluid Responsiveness on Venoarterial ECMO

VA ECMO allows organ perfusion and oxygenation while awaiting myocardial recovery, cardiac transplantation, or long-term mechanical circulatory support. Diagnosis of hospital-acquired pneumonia (HAP) is a daily challenge for the clinician managing patients on venoarterial ECMO. Lung ultrasound (US) can be a valuable tool as the initial imaging modality for the diagnosis of pneumonia. Point-of-care US (POCUS) is broadly used in patients with ARDS. POCUS is recommended to be performed regularly in COVID-19 patients for respiratory failure management. In this review, we summarized the US characteristics of COVID-19 patients, mainly focusing on lung US and echocardiography. Point-of-care lung US (LUS) was demonstrated to be an effective tool in case of acute respiratory failure for ICU patients, community-acquired pneumonia, and ventilator-associated pneumonia. This review describes the usefulness of LUS in the early detection of HAP in cardiac critically ill patients under VA ECMO as well as assess its sonographic features.