Emergency physician-performed transesophageal echocardiography for extracorporeal life support vascular cannula placement

Introduction There is growing interest and application of extracorporeal membrane oxygenation (ECMO) as a life-saving procedure for out-of-hospital cardiac arrest (OHCA), also called extracorporeal life support (ECLS). Extracorporeal membrane oxygenation cannulation with ongoing chest compressions is challenging, and transesophageal echocardiography (TEE) is an invaluable tool with which to guide ECMO wire guidance and cannula positioning. Methods We describe our protocol for TEE guidance by emergency physicians in our hospital. Results Of our first 12 cases of ECLS, 10 have had TEE guidance by an emergency physician with successful placement and without complication or need for repositioning. Emergency physician–performed TEE for ECLS vascular cannula placement has been both feasible and useful in our experience and warrants further study.