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Current opinion in critical care
06 01, 2022;28 (3): 348-359.

Monitoring during extracorporeal membrane oxygenation.

Diana Morales Castro, Idunn Morris, Ricardo Teijeiro-Paradis, Eddy Fan
Author Information
  1. Diana Morales Castro: Interdepartmental Division of Critical Care Medicine, Toronto General Hospital.
  2. Idunn Morris: Interdepartmental Division of Critical Care Medicine, Toronto General Hospital.
  3. Ricardo Teijeiro-Paradis: Interdepartmental Division of Critical Care Medicine, Toronto General Hospital.
  4. Eddy Fan: Interdepartmental Division of Critical Care Medicine, Toronto General Hospital.
PMID: 35275878 DOI: 10.1097/MCC.0000000000000939

Abstract

PURPOSE OF REVIEW: Extracorporeal membrane oxygenation (ECMO) offers advanced mechanical support to patients with severe acute respiratory and/or cardiac failure. Ensuring an adequate therapeutic approach as well as prevention of ECMO-associated complications, by means of timely liberation, forms an essential part of standard ECMO care and is only achievable through continuous monitoring and evaluation. This review focus on the cardiorespiratory monitoring tools that can be used to assess and titrate adequacy of ECMO therapy; as well as methods to assess readiness to wean and/or discontinue ECMO support.
RECENT FINDINGS: Surrogates of tissue perfusion and near infrared spectroscopy are not standards of care but may provide useful information in select patients. Echocardiography allows to determine cannulas position, evaluate cardiac structures, and function, and diagnose complications. Respiratory monitoring is mandatory to achieve lung protective ventilation and identify early lung recovery, surrogate measurements of respiratory effort and ECMO derived parameters are invaluable in optimally managing ECMO patients.
SUMMARY: Novel applications of existing monitoring modalities alongside evolving technological advances enable the advanced monitoring required for safe delivery of ECMO. Liberation trials are necessary to minimize time sensitive ECMO related complications; however, these have yet to be standardized.

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MeSH Term

Echocardiography
Extracorporeal Membrane Oxygenation
Heart Failure
Humans
Monitoring, Physiologic
Respiration, Artificial
Journal Article Review
Article has an altmetric score of 23

Word Cloud

Created with Highcharts 10.0.0ECMOmonitoringpatientscomplicationsmembraneoxygenationadvancedsupportrespiratoryand/orcardiacwellcareassesslungPURPOSEOFREVIEW:ExtracorporealoffersmechanicalsevereacutefailureEnsuringadequatetherapeuticapproachpreventionECMO-associatedmeanstimelyliberationformsessentialpartstandardachievablecontinuousevaluationreviewfocuscardiorespiratorytoolscanusedtitrateadequacytherapymethodsreadinessweandiscontinueRECENTFINDINGS:SurrogatestissueperfusionnearinfraredspectroscopystandardsmayprovideusefulinformationselectEchocardiographyallowsdeterminecannulaspositionevaluatestructuresfunctiondiagnoseRespiratorymandatoryachieveprotectiveventilationidentifyearlyrecoverysurrogatemeasurementseffortderivedparametersinvaluableoptimallymanagingSUMMARY:NovelapplicationsexistingmodalitiesalongsideevolvingtechnologicaladvancesenablerequiredsafedeliveryLiberationtrialsnecessaryminimizetimesensitiverelatedhoweveryetstandardizedMonitoringextracorporeal

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