# Transthoracic Echocardiography-guided ECMO Cannulation in the Emergency Department: A Case Report

## TL;DR

A patient in septic shock and cardiac arrest was successfully treated with ECMO using echocardiography guidance in the emergency department, leading to full recovery.

## Contribution

This case report highlights the effective use of transthoracic echocardiography for emergency ECMO cannulation in the ED.

## Key findings

- Transthoracic echocardiography successfully guided ECMO cannulation in a critically ill ED patient.
- The patient made a full recovery after one month in the ICU following TTE-guided ECMO initiation.
- TTE can be a viable alternative to transesophageal echocardiography and fluoroscopy in emergency ECMO scenarios.

## Abstract

Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention that has become more prevalent in the emergency department (ED) for patients with potentially reversible cardiac or pulmonary failure.

We report a case of a young male patient who presented in septic shock and ultimately suffered a cardiac arrest in the ED. Extracorporeal membrane oxygenation was initiated after multiple rounds of cardiopulmonary resuscitation proved futile. Transthoracic echocardiography (TTE) was employed in the ED to guide ECMO cannulation, and the patient was able to make a full recovery after a one-month admission in the intensive care unit.

Transesophageal echocardiography and fluoroscopy are often favored over TTE for ECMO cannulation due to greater resolution of the former modalities. Transesophageal echocardiography is invasive, less accessible, and requires greater expertise. Fluoroscopy requires patients to be moved to a catheterization suite and comes with a risk of extra radiation and contrast-induced nephropathy. While the concept of TTE-guided ECMO cannulation is not especially novel, few case reports exist on its emergent deployment in the ED. Here, we discuss a unique case in which TTE proved effective for timely ECMO deployment for a critically ill ED patient.