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Review
. 2020 Jun;8(12):792.
doi: 10.21037/atm.2020.03.186.

Hemodynamic monitoring in patients with venoarterial extracorporeal membrane oxygenation

Ying Su  1 , Kai Liu  1 , Ji-Li Zheng  2 , Xin Li  3 , Du-Ming Zhu  1 , Ying Zhang  1 , Yi-Jie Zhang  1 , Chun-Sheng Wang  3 , Tian-Tian Shi  4 , Zhe Luo  1   5 , Guo-Wei Tu  1
Affiliations
Review

Hemodynamic monitoring in patients with venoarterial extracorporeal membrane oxygenation

Ying Su et al. Ann Transl Med. 2020 Jun.

Abstract

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an effective mechanical circulatory support modality that rapidly restores systemic perfusion for circulatory failure in patients. Given the huge increase in VA-ECMO use, its optimal management depends on continuous and discrete hemodynamic monitoring. This article provides an overview of VA-ECMO pathophysiology, and the current state of the art in hemodynamic monitoring in patients with VA-ECMO.

Keywords: Perfusion; cardiac output (CO); echocardiography; microcirculation; shock; veno-arterial extracorporeal membrane oxygenation (VA-ECMO).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm.2020.03.186). The series “Hemodynamic Monitoring in Critically Ill Patients” was commissioned by the editorial office without any funding or sponsorship. GWT served as the unpaid Guest Editor of the series and serves as an unpaid Section Editor of Annals of Translational Medicine from May 2018 to Sep 2020. The other authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Biventricular hemodynamics during VA-ECMO support. (A) The impact of VA-ECMO on right ventricle (RV) pressure–volume (PV) loops, with a flow dependent decrease in right ventricle end-diastolic volume (RVEDV), and decreases in RV stroke volume in a fixed RV contractility and pulmonary vascular resistance (PVR) setting. (B) The impact of VA-ECMO on left ventricle (LV) PV loops, with a flow dependent increase in left ventricle end-diastolic volume (LVEDV), increases of arterial elastance (Ea) and decreases in LV stroke volume in a setting of fixed LV contractility.
Figure 2
Figure 2
Hemodynamic assessment methods in a patient with VA-ECMO support. VA-ECMO, veno-arterial extracorporeal membrane oxygenation; rStO2, regional saturation of tissue oxygen; SvO2, mixed venous oxygen saturation; ScvO2, central-venous oxygen saturation; PAWP, pulmonary artery wedge pressure; RAP, right atrial pressure; PVD, perfused vessel density; TVD, total vessel density; PPV, percent perfused vessels.
Figure 3
Figure 3
Three dimensions of hemodynamic monitoring during VA-ECMO. Hemodynamic responses during VA-ECMO support are complex and vary among patients due to multiple clinical variables. Three dimensions of hemodynamic monitoring interacting closely are summarized as follows: perfusion, flow and cardiac function. SV, stroke volume; VTI, aortic time–velocity integral; LPM, liter per minute; SGF, sweep gas flow; FDO2, fraction of delivered oxygen; PVD, perfused vessel density; TVD, total vessel density; PPV, percent perfused vessels; LVEF, left ventricular ejection fraction; TDSa, tissue Doppler lateral mitral annulus peak systolic; TAPSE, tricuspid annular plane systolic excursion; PAWP, pulmonary artery wedge pressure; CVP, central venous pressure; PAP, pulmonary artery pressure; UO, urinary output; CRT, capillary refill time; SvO2, mixed venous oxygen saturation; ScvO2, central-venous oxygen saturation; rStO2, regional saturation of tissue oxygen.
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