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Hemodynamic monitoring in the extracorporeal membrane oxygenation patient

Krishnan, Sundara; Schmidt, Gregory A.b

Current Opinion in Critical Care: June 2019 - Volume 25 - Issue 3 - p 285–291
doi: 10.1097/MCC.0000000000000602
CARDIOPULMONARY MONITORING: Edited by Anthony S. McLean
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Purpose of review Hemodynamic monitoring in ECMO patients requires familiarity with the underlying pathophysiology and circulatory mechanics of extracorporeal flow. This review discusses the various monitoring modalities relevant to the management of patients on venovenous ECMO (VV ECMO) and venoarterial (VA ECMO). We emphasize tools to judge the adequacy of perfusion, predict the response to fluid boluses, measure right ventricular function, assess left ventricular distention (for VA ECMO), and monitor the process of weaning from ECMO. We emphasize how differences between VV ECMO and VA ECMO are reflected in distinct approaches to monitoring.

Recent findings Point-of-care ultrasound and near-infrared spectroscopy can play a significant role in monitoring of global and regional perfusion.

Summary Recent literature in hemodynamic monitoring of ECMO patients is discussed, with comparison of VV ECMO and VA ECMO. Many common monitoring tools lack validity during ECMO: by taking into account the unique physiology of the ECMO circulation, selected methods can aid in the care of these complex patients.

aDepartment of Anesthesia

bDivision of Pulmonary Diseases, Critical Care, and Occupational Medicine, University of Iowa, Iowa City, USA

Correspondence to Professor Gregory A. Schmidt, MD, Division of Pulmonary Diseases, Critical Care, and Occupational Medicine, University of Iowa, Iowa City, IA 52242, USA. E-mail: Gregory-a-schmidt@uiowa.edu

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