Buchtele N, Staudinger T, Schwameis M, et al. - The feasibility and safety of contrast-enhanced ultrasound (CEUS) was examined to identify the watershed at the bedside in patients on bifemoral venoarterial extracorporeal membrane oxygenation (VA ECMO) at three ICUs of a European tertiary care facility. Researchers conducted CEUS as soon as possible after ECMO-initiation (Cardiohelp, Maquet, Germany) using SonoVue contrast media. Transesophageal echocardiography and transabdominal sonography (3–5 MHz curvilinear probe) were conducted concomitantly to show mid-esophageal aortic valve, ascending, descending aorta, and upper esophageal aortic arch long-axis views as well as longitudinal views of the proximal (below diaphragm), mid (level of renal arteries), and distal (above iliac bifurcation) abdominal aorta. Random-effects general linear regression models were applied to calculate mean changes for each safety variable (mean ± SD). The study found pulsatility of the left radial arterial waveform and opening of the aortic valve in all patients. After CEUSA, acoustic bubble detection occurred in all patients. No changes in the safety variables related to CEUS occurred. It was noted that CT imaging of the brain (8/10 patients) revealed no cerebral lesions suggesting particle embolism.