Use of point-of-care ultrasound (POCUS) to monitor neonatal and pediatric extracorporeal life support
Abstract
Extracorporeal membrane oxygenation (ECMO) is an invasive life support technique that requires a blood pump, an artificial membrane lung, and vascular cannulae to drain de-oxygenated blood, remove carbon dioxide, oxygenate, and return it to the patient. ECMO is generally used to provide advanced and prolonged cardiopulmonary support in patients with refractory acute cardiac and/or respiratory failure. After its first use in 1975 to manage a severe form of meconium aspiration syndrome with resultant pulmonary hypertension, the following years were dominated by the use of ECMO to manage neonatal respiratory failure and limited to a few centers across the world. In the 1990s, evidence for neonatal respiratory ECMO support increased; however, the number of cases began to decline with the use of newer pharmacologic therapies (e.g., inhaled nitric oxide, exogenous surfactant, and high-frequency oscillatory ventilation). On the contrary, pediatric ECMO sustained steady growth. Combined advances in ECMO technology and bedside medical management have improved general outcomes, although ECMO-related complications remain challenging. Point-of-care ultrasound (POCUS) is an essential tool to monitor all phases of neonatal and pediatric ECMO: evaluation of ECMO candidacy, ultrasound-guided ECMO cannulation, daily evaluation of heart and lung function and brain perfusion, detection and management of major complications, and weaning from ECMO support. Conclusion: Based on these considerations and on the lack of specific guidelines for the use of POCUS in the neonatal and pediatric ECMO setting, the aim of this paper is to provide a systematic overview for the application of POCUS during ECMO support in these populations. What is Known: • Extracorporeal membrane oxygenation (ECMO) provides advanced cardiopulmonary support for patients with refractory acute cardiac and/or respiratory failure and requires appropriate monitoring. • Point-of-care ultrasound (POCUS) is an accessible and adaptable tool to assess neonatal and pediatric cardiac and/or respiratory failure at bedside. What is New: • In this review, we discussed the use of POCUS to monitor and manage at bedside neonatal and pediatric patients supported with ECMO. • We explored the potential use of POCUS during all phases of ECMO support: pre-ECMO assessment, ECMO candidacy evaluation, daily evaluation of heart, lung and brain function, detection and troubleshooting of major complications, and weaning from ECMO support.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Echocardiography can help understand the cardiovascular physiology and anatomy of the neonate.
“Echocardiography can help us to understand the cardiovascular physiology and anatomy of the neonate”
From Innovative wearable technology for continuous echocardiographic monitoring: first-in-neonate case report (2025) · cites this paper as [6]
Echocardiography can help identify congenital cardiac defects.
“identify congenital cardiac defects”
From Innovative wearable technology for continuous echocardiographic monitoring: first-in-neonate case report (2025) · cites this paper as [6]
Echocardiography can help quantify ventricular function and volume to guide clinical decision making during surgery.
“quantify ventricular function and volume to guide clinical decision making during surgery (6, 7).”
From Innovative wearable technology for continuous echocardiographic monitoring: first-in-neonate case report (2025) · cites this paper as [6]
Cites
Papile, L. A., Burstein, J., Burstein, R., & Koffler, H. (1978) · The Journal of Pediatrics · doi:10.1016/s0022-3476(78)80282-0 · Cited by 6,435 · see citing works
Bedside Ultrasound Assessment of Positive End-Expiratory Pressure–induced Lung Recruitment
Bouhemad, B., Brisson, H., Guen, M. L., Arbelot, C., Lü, Q., & Rouby, J. (2010) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201003-0369oc · Cited by 735 · see citing works
Singh, Y., Tissot, C., Fraga, M. V., Yousef, N., Cortes, R. G., Lopez, J., Sanchez-de-Toledo, J., Brierley, J., Colunga, J. M., Raffaj, D., et al. (2020) · Critical Care · doi:10.1186/s13054-020-2787-9 · Cited by 659 · see citing works
Self-citationBrat, R., Yousef, N., Klifa, R., Reynaud, S., Shankar‐Aguilera, S., & Luca, D. D. (2015) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2015.1797 · Cited by 474 · see citing works
Aïssaoui, N., Luyt, C. E., Leprince, P. N., Trouillet, J., Léger, P., Pavie, A., Diébold, B., Chastre, J. E., & Combes, A. (2011) · Intensive Care Medicine · doi:10.1007/s00134-011-2358-2 · Cited by 361 · see citing works
Chiumello, D., Mongodi, S., Algieri, I., Vergani, G. L., Orlando, A., Via, G., Crimella, F., Cressoni, M., & Mojoli, F. (2018) · Critical Care Medicine · doi:10.1097/ccm.0000000000003340 · Cited by 309 · see citing works
Quantitative Lung Ultrasound: Technical Aspects and Clinical Applications
Mongodi, S., Luca, D. D., Colombo, A., et al. (2021) · Anesthesiology · doi:10.1097/aln.0000000000003757 · Cited by 267 · see citing works
Platts, D. G., Fraser, J. F., Burstow, D. J., Mullany, D. V., & Fraser, J. F. (2011) · Journal of the American Society of Echocardiography · doi:10.1016/j.echo.2011.11.009 · Cited by 200 · see citing works
Polito, A., Barrett, C., Wypij, D., Rycus, P. T., Netto, R., Cogo, P. E., & Thiagarajan, R. R. (2013) · Intensive Care Medicine · doi:10.1007/s00134-013-2985-x · Cited by 200 · see citing works
Lung Ultrasound for Diagnosing Pneumothorax in the Critically Ill Neonate
Raimondi, F., Rodríguez‐Fanjul, J., Aversa, S., Chirico, G., Yousef, N., Luca, D. D., Corsini, I., Dani, C., Grappone, L., Orfeo, L., et al. (2016) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2016.04.018 · Cited by 199 · see citing works
Echocardiography for adult patients supported with extracorporeal membrane oxygenation
Douflé, G., Roscoe, A., Billia, F., et al. (2015) · Critical Care · doi:10.1186/s13054-015-1042-2 · Cited by 168 · see citing works
Imaging in acute respiratory distress syndrome
Pesenti, A. M., Musch, G., Lichtenstein, D. A., Mojoli, F., Amato, M. B. P., Cinnella, G., Gattinoni, L., & Quintel, M. (2016) · Intensive Care Medicine · doi:10.1007/s00134-016-4328-1 · Cited by 148 · see citing works
Weaning from veno-arterial extra-corporeal membrane oxygenation: which strategy to use?
Ortuno, S., Delmas, C., Diehl, J., et al. (2019) · Annals of Cardiothoracic Surgery · doi:10.21037/acs.2018.08.05 · Cited by 127 · see citing works
Lung Ultrasound for the Differential Diagnosis of Respiratory Distress in Neonates
Corsini, I., Parri, N., Gozzini, E., et al. (2018) · Neonatology · doi:10.1159/000493001 · Cited by 111 · see citing works
ECMO and Right Ventricular Failure: Review of the Literature
Grant, C., Richards, J. B., Frakes, M. A., et al. (2020) · Journal of Intensive Care Medicine · doi:10.1177/0885066619900503 · Cited by 111 · see citing works
Chinese Critical Ultrasound Study Group (CCUSG), Wang, X., Ding, X., Zhang, H., Chen, H., Su, L., & Liu, D. (2016) · Critical Care · doi:10.1186/s13054-016-1558-0 · Cited by 100 · see citing works
Mongodi, S., Pozzi, M., Orlando, A., et al. (2017) · Intensive Care Medicine · doi:10.1007/s00134-017-4941-7 · Cited by 85 · see citing works
Kim, D., Jang, W. J., Park, T. K., et al. (2020) · Journal of the American Society of Echocardiography · doi:10.1016/j.echo.2020.12.002 · Cited by 75 · see citing works
Donker, D. W., Meuwese, C. L., Braithwaite, S. A., Broomé, M., van der Heijden, J., Hermens, J. A. J. M., Platenkamp, M., de Jong, M., Janssen, J. G. D., Balík, M., et al. (2018) · Perfusion · doi:10.1177/0267659118766438 · Cited by 58 · see citing works
Avalon catheters in pediatric patients requiring ECMO: Placement and migration problems
Jarboe, M. D., Gadepalli, S. K., Church, J. T., et al. (2017) · Journal of Pediatric Surgery · doi:10.1016/j.jpedsurg.2017.10.036 · Cited by 57 · see citing works
Experience with the Avalon ® bicaval double-lumen veno-venous cannula for neonatal respiratory ECMO
Speggiorin, S., ROBINSON, S. N., Harvey, C., et al. (2014) · Perfusion · doi:10.1177/0267659114540020 · Cited by 56 · see citing works
Echocardiography for extracorporeal membrane oxygenation
Hussey, P. T., Mering, G. V., Nanda, N. C., Ahmed, M. I., & Addis, D. R. (2022) · Echocardiography · doi:10.1111/echo.15266 · Cited by 54 · see citing works
Neonatal functional echocardiography
Tissot, C., & Singh, Y. (2020) · Current Opinion in Pediatrics · doi:10.1097/mop.0000000000000887 · Cited by 47 · see citing works
Self-citationNeonatal respiratory and cardiac ECMO in Europe
Amodeo, I., Nardo, M. D., Raffaeli, G., et al. (2021) · European Journal of Pediatrics · doi:10.1007/s00431-020-03898-9 · Cited by 47 · see citing works
O'Brien, N. F., Reuter‐Rice, K., Wainwright, M. S., et al. (2020) · Journal of Pediatric Intensive Care · doi:10.1055/s-0040-1715128 · Cited by 46 · see citing works
Ntoumenopoulos, G., Buscher, H., & Scott, S. (2020) · The International Journal of Artificial Organs · doi:10.1177/0391398820948870 · Cited by 44 · see citing works
Multisite Veno-Venous Cannulation for Neonates and Nonambulatory Children*
Lillie, J., Pienaar, A., Budd, J., Speggiorin, S., Gordon, A., James, P., Perkins, J., Griffiths, B. T., Fine-Goulden, M., Austin, C. B., et al. (2021) · Pediatric Critical Care Medicine · doi:10.1097/pcc.0000000000002753 · Cited by 40 · see citing works
The Role of Imaging During Extracorporeal Membrane Oxygenation in Pediatric Respiratory Failure
Barnacle, A. M., Smith, L. C., & Hiorns, M. P. (2005) · American Journal of Roentgenology · doi:10.2214/ajr.04.1672 · Cited by 38 · see citing works
Monitoring during extracorporeal membrane oxygenation
Douflé, G., & Ferguson, N. D. (2016) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000000309 · Cited by 37 · see citing works
The evolution of cardiac point of care ultrasound for the neonatologist
Singh, Y., Bhombal, S., Katheria, A. C., Tissot, C., & Fraga, M. V. (2021) · European Journal of Pediatrics · doi:10.1007/s00431-021-04153-5 · Cited by 36 · see citing works
Self-citationHemamalini, P., Dutta, P., & Attawar, S. (2020) · Annals of Cardiac Anaesthesia · doi:10.4103/aca.aca_75_19 · Cited by 33 · see citing works
Moscatelli, A., Febbo, F., Buratti, S., et al. (2019) · Pediatric Critical Care Medicine · doi:10.1097/pcc.0000000000001918 · Cited by 32 · see citing works
Xiao, L., Arbelot, C., Schreiber, A. F., Langeron, O., Monsel, A., & Lü, Q. (2019) · Respiratory Care · doi:10.4187/respcare.06907 · Cited by 30 · see citing works
Pediatric and neonatal extracorporeal life support: current state and continuing evolution
Fallon, B. P., Gadepalli, S. K., & Hirschl, R. B. (2021) · Pediatric Surgery International · doi:10.1007/s00383-020-04800-2 · Cited by 27 · see citing works
Bhalla, A. K., Baudin, F., Takeuchi, M., et al. (2023) · Pediatric Critical Care Medicine · doi:10.1097/pcc.0000000000003163 · Cited by 27 · see citing works
Ultrasound Guided Femoral Cannulation and Percutaneous Perfusion of the Distal Limb for VA ECMO
Benassi, F., Vezzani, A., Vignali, L., et al. (2014) · Journal of Cardiac Surgery · doi:10.1111/jocs.12319 · Cited by 24 · see citing works
Tabak, B. D., Elliott, C. L., Mahnke, C. B., et al. (2012) · Journal of Clinical Ultrasound · doi:10.1002/jcu.21873 · Cited by 23 · see citing works
Lung ultrasound in children: What does it give us?
Bobillo‐Pérez, S., Girona‐Alarcón, M., Rodríguez‐Fanjul, J., et al. (2019) · Paediatric Respiratory Reviews · doi:10.1016/j.prrv.2019.09.006 · Cited by 22 · see citing works
Lillie, J., Boot, L., Speggiorin, S., et al. (2020) · Pediatric Critical Care Medicine · doi:10.1097/pcc.0000000000002340 · Cited by 21 · see citing works
Impella Management for the Cardiac Intensivist
Papolos, A. I., Barnett, C. F., Tuli, A., et al. (2022) · ASAIO Journal · doi:10.1097/mat.0000000000001680 · Cited by 19 · see citing works
Kipfmueller, F., Bo, B., Schmitt, J., et al. (2023) · Pediatric Pulmonology · doi:10.1002/ppul.26555 · Cited by 19 · see citing works
Extracorporeal Membrane Oxygenation Then and Now; Broadening Indications and Availability
Pollack, B. E., Kirsch, R. E., Chapman, R. L., et al. (2022) · Critical Care Clinics · doi:10.1016/j.ccc.2022.09.003 · Cited by 18 · see citing works
Pediatric extracorporeal membrane oxygenation (ECMO): a guide for radiologists
Thompson, A. F., Luan, J., Aklabi, M. M. A., et al. (2018) · Pediatric Radiology · doi:10.1007/s00247-018-4211-z · Cited by 17 · see citing works
Sperotto, F., Polito, A., Amigoni, A., et al. (2022) · Journal of the American Heart Association · doi:10.1161/jaha.121.023963 · Cited by 17 · see citing works
Echocardiographic Guidance During Neonatal and Pediatric Jugular Cannulation for ECMO
Salazar, P. A., Blitzer, D., Dolejs, S. C., et al. (2018) · Journal of Surgical Research · doi:10.1016/j.jss.2018.07.030 · Cited by 16 · see citing works
Use of ECMO for Cardiogenic Shock in Pediatric Population
Bhaskar, P., Davila, S. Z., Hoskote, A. U., & Thiagarajan, R. R. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10081573 · Cited by 16 · see citing works
Zhang, Y., Wang, C., Wang, F., et al. (2022) · Frontiers in Pediatrics · doi:10.3389/fped.2022.798855 · Cited by 14 · see citing works
Venovenous ECMO for Congenital Diaphragmatic Hernia: Role of Ductal Patency and Lung Recruitment
Moscatelli, A., Pezzato, S., Lista, G., et al. (2016) · PEDIATRICS · doi:10.1542/peds.2016-1034 · Cited by 12 · see citing works
The utility of cranial ultrasound as a screening tool for neonatal ECMO
McCutcheon, K. C., Wise, L. J., Lewis, K. N., et al. (2019) · Journal of Perinatal Medicine · doi:10.1515/jpm-2019-0234 · Cited by 11 · see citing works
Chilcote, D., Sriram, A., Slovis, J., et al. (2023) · Pediatric Critical Care Medicine · doi:10.1097/pcc.0000000000003325 · Cited by 11 · see citing works
Lê, N. M., Dang, U. T., Vu, H. V., et al. (2022) · BMJ Case Reports · doi:10.1136/bcr-2022-249195 · Cited by 10 · see citing works
The Role of Echocardiography in Extracorporeal Membrane Oxygenation
Hockstein, M. A., Singam, N. S. V., Papolos, A., et al. (2022) · Current Cardiology Reports · doi:10.1007/s11886-022-01827-w · Cited by 10 · see citing works
What’s new in lung ultrasound in the critically ill or injured child
Durand, P., Luca, D. D., & Tissières, P. (2018) · Intensive Care Medicine · doi:10.1007/s00134-018-5356-9 · Cited by 9 · see citing works
Nardo, M. D., Lorusso, R., Guner, Y. S., et al. (2020) · ASAIO Journal · doi:10.1097/mat.0000000000001264 · Cited by 9 · see citing works
Self-citationPawlowski, T. W., Stoller, J. Z., Rintoul, N. E., Hedrick, H. L., Quartermain, M. D., & Fraga, M. V. (2021) · Journal of Perinatology · doi:10.1038/s41372-021-00936-8 · Cited by 9 · see citing works
Hossain, M. S., Khan, F. A., Cass, D. L., et al. (2023) · Journal of Pediatric Surgery · doi:10.1016/j.jpedsurg.2023.02.021 · Cited by 9 · see citing works
Chacon, M. M., & Shillcutt, S. K. (2017) · CASE · doi:10.1016/j.case.2017.04.002 · Cited by 8 · see citing works
Wu, H.-L., Zhou, S., Chen, X., Cao, H., Zheng, Y.-R., & Chen, Q. (2023) · Heart & Lung · doi:10.1016/j.hrtlng.2023.09.006 · Cited by 8 · see citing works
Walczak, A. B., Bigelow, A. M., Schneider, B., et al. (2023) · ASAIO Journal · doi:10.1097/mat.0000000000002004 · Cited by 7 · see citing works
Konishi, H., Misawa, Y., Nakagawa, Y., et al. (1999) · Artificial Organs · doi:10.1046/j.1525-1594.1999.06193.x · Cited by 6 · see citing works
van Heijst, A. F. J., van der Staak, F. H., Hopman, J. C. W., et al. (2003) · Pediatric Critical Care Medicine · doi:10.1097/00130478-200301000-00019 · Cited by 6 · see citing works
How to unload the left ventricle during veno-arterial extracorporeal membrane oxygenation
Tavazzi, G., Alviar, C. L., Colombo, C. N. J., et al. (2023) · European Heart Journal - Cardiovascular Imaging · doi:10.1093/ehjci/jead061 · Cited by 6 · see citing works
Nardo, M. D., Stoppa, F., David, P., et al. (2017) · European Journal of Heart Failure · doi:10.1002/ejhf.855 · Cited by 4 · see citing works
Marinoni, M., Trapani, S., & Cianchi, G. (2019) · ASAIO Journal · doi:10.1097/mat.0000000000001032 · Cited by 4 · see citing works
Zhang, X., Fu, Y., Yue, G., et al. (2021) · Journal of Artificial Organs · doi:10.1007/s10047-021-01287-z · Cited by 4 · see citing works
Physiotherapy-led lung ultrasound in neonatal extra-corporeal membrane oxygenation: A case-study
Shkurka, E., & Nolan, W. (2022) · Perfusion · doi:10.1177/02676591221094410 · Cited by 3 · see citing works
Nardo, M. D., Matteis, G. M. D., Cecchetti, C., et al. (2010) · PubMed · Cited by 2 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Wang, Y., Wu, G., Song, J., Song, H., & Chu, Q. (2025) · Frontiers in Pediatrics · doi:10.3389/fped.2025.1567386 · Cited by 8 · see citing works
- Authors
- Bianzina, S., Singh, Y., Iacobelli, R., Amodeo, A., Guner, Y., & Di Nardo, M.
- Affiliations
- Istituto Giannina Gaslini (IT)
- Loma Linda University Medical Center (US)
- Bambino Gesù Children's Hospital (IT)
- Children's Hospital of Orange County (US)
- Venue
- European Journal of Pediatrics
- Published
- 2024-01-18
- Volume
- 183
- Issue
- 4
- Pages
- 1509-1524
- ISSN
- 0340-6199 (ISSN-L)
- 1432-1076
- OpenAlex
- W4390964892
- Cited by
- 8
- References
- 67
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 2
- FWCI
- 0.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- European Journal of Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ministero della Salute
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Mechanical Circulatory Support Devices
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Ultrasound in Clinical Applications
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Keywords
- point-of-care ultrasound, extracorporeal membrane oxygenation, neonatal ECMO, pediatric ECMO, ECMO cannulation, ECMO complications, ECMO weaning, cerebral perfusion
- MeSH terms
- Child, Female, Humans, Infant, Infant, Newborn, Meconium Aspiration Syndrome, Nitric Oxide, Respiratory Insufficiency, Ultrasonography, Extracorporeal Membrane Oxygenation, Point-of-Care Systems
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
