Hemodynamic Monitoring in Patients With Venoarterial Extracorporeal Membrane Oxygenation

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an effective mechanical circulatory support modality that rapidly restores systemic perfusion in cardiogenic shock patients, over days or weeks. Patients receiving VA-ECMO support, and institutions offering ECMO support are rapidly increasing. Generally, the main indications for VA-ECMO are refractory circulatory failures, including medical or post-cardiotomy shock, cardiac arrest, refractory ventricular tachycardia, and the acute management of invasive procedure complications. The fundamental purpose of VA-ECMO support is a bridge to recovery, to heart transplantation, to a more durable bridge, or to decision. Currently, there is no consensus on the daily management of VA-ECMO patients, due a lack of clinical evidence. Optimal management approaches involve several inputs such as circulatory support, infection prevention and nutrition support, where hemodynamic monitoring plays a fundamental role in VA-ECMO, from initiation to weaning.

This article provides an overview of VA-ECMO pathophysiology, and reviews current knowledge of hemodynamic monitoring assessments in patients with peripheral VA-ECMO.