Extracorporeal membrane oxygenation: a radiologists' guide to who, what and where

Extracorporeal membrane oxygenation (ECMO) is the short-term (days to weeks) support of patients with severe respiratory and/or cardiac failure. The use of these devices has been well established in paediatric and post-heart and lung transplantation patients; however, its use in patients with severe acute respiratory distress syndrome (ARDS) has gained acceptance as standard clinical practice over the past decade. The results of the CESAR trial (Conventional ventilation or ECMO for Severe Adult Respiratory failure) showed significant survival benefit for patients with ARDS undergoing ECMO. Substantial numbers of radiological examinations are performed in this patient group, prompting the need for general radiologists to understand the radiological appearances of these devices and associated complications. In this review, we highlight the uses, subtypes, physiology, normal appearances, and complications of ECMO. An example of the chronological radiographic images in the perioperative period demonstrates the importance of discriminating normal appearances associated with EMCO.