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. 2020 Jul 15:NEJMcpc2004975. doi: 10.1056/NEJMcpc2004975

Figure 2. Studies Obtained after Initiation of Mechanical Circulatory Support.

Figure 2

A chest radiograph obtained after venoarterial extracorporeal membrane oxygenation (ECMO) cannulation (Panel A) shows satisfactory positioning of the venous ECMO cannula (arrowheads) in the right atrium, as well as satisfactory positioning of the endotracheal tube and the pulmonary-artery catheter. A transesophageal echocardiogram obtained during ECMO (Panel B) shows decompression of the left ventricular cavity, with a decreased left ventricular dimension (dashed line). However, wall thickness in both the left ventricle (double arrow) and the right ventricle is increased, as compared with ultrasonographic findings from the previous day, which suggests myocardial edema. A portable chest radiograph obtained after ECMO decannulation and placement of right and left ventricular assist devices (RVAD and LVAD, respectively) (Panel C) shows satisfactory positioning of the RVAD (arrows; the RVAD tip is in the pulmonary trunk, and the catheter is in the left main pulmonary artery) and of the transaortic LVAD (arrowheads). The radiograph also shows small bilateral pleural effusions, as well as development of diffuse bilateral airspace opacities, a finding consistent with alveolar pulmonary edema.