The assessment of cardiac function in veno-venous extracorporeal membrane oxygenation: the emerging role of bedside echocardiography

The management of patients with acute respiratory distress syndrome (ARDS) has deeply changed in recent years. While the ventilatory strategy was initially focused on the lung, now it also considers pulmonary vascular injury and its effects on the right ventricle and on hemodynamics. This is mainly due to echocardiography, which allows intensivists to evaluate accurately, non invasively and at bedside right ventricular function (RV) at baseline and after adaptation of ventilatory settings. This “new” ventilatory approach was summarized as “what is good for the lung is good for the right ventricle” (1) and, though not validated in randomized controlled trials, an RV protective approach was recently formalized as a stepby-step approach to the ventilatory strategy, putting the pulmonary circulation and the right ventricle (and thus echocardiography) at the center of the decision-making process (1, 2). Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a well-established therapy in patients with ARDS unresponsive to conventional therapy and it is being increasingly used in these patients. However, so far, there is a paucity of data (mainly including case reports and observational studies) delineating the role of echocardiography in the management of adult patients supported by VV ECMO (3). E di to ri al