Invasive Hemodynamic and Physiologic Considerations in Patients Undergoing Extracorporeal Membrane Oxygenation

Intraoperative Management of Adult Patients on Extracorporeal Membrane Oxygenation: An Expert Consensus Statement From the Society of Cardiovascular Anesthesiologists—Part II, Intraoperative Management and Troubleshooting

“…8 Additionally, manual injection thermodilution is inaccurate because some injected fluid flows into the ECMO drainage cannula, rather than across the tricuspid valve. 9 Fick method cardiac output measurements are inaccurate because gas exchange occurs in both the lungs and oxygenator. 9 PACs can accurately measure pulmonary artery pressure and pulmonary capillary wedge pressure in VA ECMO patients.…”

“…9 Fick method cardiac output measurements are inaccurate because gas exchange occurs in both the lungs and oxygenator. 9 PACs can accurately measure pulmonary artery pressure and pulmonary capillary wedge pressure in VA ECMO patients. PACs can also be used to measure cardiac output immediately after weaning from VA ECMO, and this may help guide hemodynamic interventions during this critical period.…”

“…Thermodilution and Fick estimates of cardiac output are also not reliable in VV ECMO patients and have an error margin as high as 3 liters per minute, especially when ECMO circuit blood flow is high. 9,10 Oxygen saturation in the pulmonary artery does not reflect cardiac output in VV ECMO patients, as blood in the pulmonary artery usually has an oxygen saturation near 100%.…”