ECMO
Our Comprehensive Noninvasive Hemodynamic Monitoring Solution for ECMO
The use of Extracorporeal Membrane Oxygenation (ECMO) is increasing for patients suffering from cardiac and respiratory failure. ECMO provides prolonged pulmonary and/or circulatory support by removing venous blood, pumping it across an oxygenator for gas exchange, and returning the oxygenated blood back to the patient. The purpose is to help restore, support, and maintain systemic perfusion. Although there is no consensus on daily management, general guidelines have been developed for the optimal management for patients undergoing ECMO where hemodynamic monitoring has been proven to be an integral part from initiation to weaning [1].
Hemodynamic monitoring for patients undergoing ECMO provides intensivists with early early identification and intervention capabilities before the development of irreversible injuries. 3 key aspects that are monitored are:
Perfusion in order to maintain optimal blood flow and oxygen supply for adequate systemic and global tissue perfusion.
Adequate Flow in order to balance the patient’s native blood flow to the external ECMO flow.
Cardiac Function in order to prevent further cardiac dysfunction or failure.
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The current gold standard for hemodynamic management is by using a pulmonary artery catheter (PAC) or central venous catheter (CVC). Due to the complexity and highly invasive nature of these catheters, the chance of infection and catheter-related complications is high and it has been suggested that PAC should not be used routinely in hemodynamically unstable patients [2]. Transthoracic Echocardiography (TTE) is an accurate and precise method for estimating cardiac hemodynamics however it provides intermittent measurements and there is high operator dependency [3]. Easy to use, noninvasive, and continuous hemodynamic monitoring coupled with guidelines is a critical tool needed for intensivists to support patients on ECMO.
“Optimal management approaches involved 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”
ANN TRANSL ED 2020;8(12):792
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Our Comprehensive Hemodynamic Monitoring Solution for ECMO
Mespere LifeSciences has developed a completely noninvasive, comprehensive, cardiac and cerebral hemodynamic monitoring platform that meets all 3 key monitoring aspects.
Cardiac Monitoring
The VenArt Cardiac Output monitoring system noninvasively obtains venous and arterial oxygen saturation values - and then performs a beat-by-beat Fick Principle calculation in order to derive cardiac output, cardiac index, stroke volume, and stroke volume variations.
Perfusion
Venous Oxygen Saturation (SjvO2) – systemic oxygen consumption
Arterial Oxygen Saturation (SpO2) – systemic oxygen supply
Adequate Flow
Cardiac Output (CO) – native cardiac blood flow
Cardiac Function
Stroke Volume (SV) – left ventricular function
Venous and Arterial Waveforms – pulsatility
“THE BEST MEASURE OF ADEQUATESYSTEMIC PERFUSION IS VENOUSSATURATION GREATER THAN 70%”
ELSO GUIDELINES V1.4
“DURING ECMO REDUCTION,MONITORING CENTRAL VENOUS ANDARTERIAL SATURATION WASESSENTIAL”
J THORAC CARDIOVASC SURG 2011;142:1199
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Cerebral & Tissue Monitoring
The only cerebral and tissue oximeter with both regional oxygenation and blood volume, proving to be the most accurate, cost effective, and user friendly cerebral and tissue oximetry system on the market
Perfusion
Regional Tissue Oxygen Saturation (StO2) – balance between oxygen delivery and consumption for cerebral and/or lower extremity tissue
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Adequate Flow
Blood Volume Index (BVI) – blood volume in the regional tissue beneath the sensor
"CONTINUOUS MONITORING OFCEREBRAL AND LOWER EXTREMITYREGIONAL SATURATION OXYGENLEVELS COULD PROVIDE INTENSIVISTSWITH EARLY IDENTIFICATION ANDINTERVENTION CAPABILITIES BEFORETHE DEVELOPMENT OF IRREVERSIBLEINJURY, AND COULD SERVE AS ANADJUNCTIVE INDICATOR OFNEUROLOGIC OR LOWER EXTREMITYSTATUS IN VA-ECMO PATIENTS”
ANN TRANSL ED 2020;8(12):792
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Mespere LifeSciences' ECMO Solution PDF Download
References​
1. Su Y, Liu K, Zheng JL, Li X, Zhu DM, Zhang Y, Zhang YJ, Wang CS, SHI TT, Luo Z, Tu GW. Hemodynamic Monitoring in patients with venoarterial extracoporeal membrane oxygenation, Ann Transl Med2020;8(12):792 l http://dx.doi/org/10.21037/atm.2020.03.186
2. Siegel MD, Siemieniuk R. Acute respiratorydistress syndrome: Supportive care and oxygenation in adults:2020. [https://www.uptodate.com/contents/acute-respiratory-distress-syndrome-supportive-care-andoxygenation-in-adults] UpToDate; 2020
3.Mayo P, Beaulieu Y, Doelken P, Feller-Kopman D,Harrod C, Kaplan A, et al. American College of Chest Physicians/La Société deRéanimation de Langue Française statement on competence in critical careultrasonography. Chest. 2009;135:1050–60.
4.Extracorporeal Life Support Organization - General Guidelines for all ECLS Cases August 2017. Version 1.4
5.Khan I, Rehan M, Parikh G, Zammit C, Badjatia N, Herr D, Kon Z, Hogue C and Mazzefi M (2018) Regional Cerebral Oximetry as an Indicator of Acute Brain Injury in Adults Undergoing Veno-ArterialExtracoporeal Membrane Oxygenation-A Prospective Pilot Study. Front. Neurol. 9:993. doi:10.3389/fneur.2018.00993