Which cardiovascular monitoring on veno-arterial extracorporeal membrane oxygenation

To discuss the hemodynamic monitoring techniques to quantify cardiac output, to assess the adequacy of perfusion, and to evaluate cardiac as well as pump preload and fluid responsiveness in patients supported by veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Echocardiography is essential in the hemodynamic assessment of VA-ECMO patients. However, intermittent echocardiography should be complemented by continuous, potentially nurse driven, monitoring techniques. We will focus on invasive and noninvasive hemodynamic monitoring methods beyond echocardiography.

Despite the importance of comprehensive hemodynamic monitoring in the provision of safe, adequate, and well balanced VA-ECMO support, limited data are currently available in this specific patient population. While some measurements (intravascular pressures, oxygen saturation) remain valid and provide important information on the hemodynamic state, measurements of cardiac output are invalid with many of the hemodynamic monitoring methods. Many of the routinely used monitoring methods must be interpreted with caution during VA-ECMO support.

A thorough understanding of the various hemodynamic monitoring methods and the physiological interactions between VA-ECMO and patients is essential for selecting the optimal hemodynamic monitoring strategy and correctly interpreting the resulting hemodynamic measurements.