Hemodynamic Monitoring during Veno-Venous Extracorporeal Membrane Oxygenation: A scoping review

Abstract

Background Optimizing cardiovascular monitoring and support during veno-venous Extracorporeal Membrane Oxygenation (V-V ECMO) is essential to ensure overall adequacy of end-organ perfusion and proper titration of extracorporeal support. Despite an increasing V-V ECMO use, guidelines on monitoring of cardiovascular function during mechanical support are lacking, with current approaches mostly based on clinicians’ experience rather than evidence-based recommendations. This scoping review focused on basic and more advance methods for hemodynamic monitoring during V-V ECMO in adult patients. Methods Databases (PubMed, EMBASE and Cochrane CENTRAL) and reference lists of relevant articles were searched from inception until November 2021. We included studies of any methodology that addressed the a priori key questions relating to hemodynamic monitoring during respiratory extracorporeal support. Results Overall, 465 articles were screened, and 106 articles were included for detailed analysis. Protocolized hemodynamic monitoring and lines of evidence were not found and in particular the main body of the literature was concentrated on cardiocirculatory support. Tools recommendations regarding the available monitoring techniques are described, with an overview of basic, prognostic/diagnostic and advanced methods. While these strategy does not influence time to wean, the application of care bundles and multidisciplinary team approaches could be associated with reduced complications and improved outcomes. Conclusions Patients undergoing respiratory support with V-V ECMO experience complex interactions among the patient’s and extracorporeal circulation, individual’s lung function and related circulatory changes. The critical needs for multidisciplinary teams, specified trainings, new research directions, and an accurate monitoring aiming to improve outcomes are essential for optimal decision-making.