Department of Anesthesia.
Division of Pulmonary Diseases, Critical Care, and Occupational Medicine, University of Iowa, Iowa City, USA.
Curr Opin Crit Care. 2019 Jun;25(3):285-291. doi: 10.1097/MCC.0000000000000602.
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.
Point-of-care ultrasound and near-infrared spectroscopy can play a significant role in monitoring of global and regional perfusion.
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.
体外膜肺氧合（ECMO）患者的血流动力学监测需要熟悉体外血流的基础病理生理学和循环力学。本文讨论了与静脉-静脉 ECMO（VV ECMO）和静脉-动脉（VA ECMO）患者管理相关的各种监测方式。我们强调了判断灌注是否充分、预测对液体冲击的反应、评估右心室功能、评估左心室扩张（VA ECMO 时）以及监测 ECMO 脱机过程的工具。我们强调了 VV ECMO 和 VA ECMO 之间的差异如何反映在不同的监测方法上。
即时床旁超声和近红外光谱可在整体和局部灌注监测中发挥重要作用。
本文讨论了 ECMO 患者血流动力学监测的最新文献，并对 VV ECMO 和 VA ECMO 进行了比较。许多常见的监测工具在 ECMO 期间缺乏有效性：通过考虑 ECMO 循环的独特生理学，可以选择特定的方法来帮助这些复杂的患者。
