Transpulmonary thermodilution before and during veno-venous extra-corporeal membrane oxygenation ECMO: an observational
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ORIGINAL RESEARCH
Transpulmonary thermodilution before and during veno‑venous extra‑corporeal membrane oxygenation ECMO: an observational study on a potential loss of indicator into the extra‑corporeal circuit Alexander Herner1 · Tobias Lahmer1 · Ulrich Mayr1 · Sebastian Rasch1 · Jochen Schneider1 · Roland M. Schmid1 · Wolfgang Huber1,2 Received: 24 February 2019 / Accepted: 7 October 2019 © Springer Nature B.V. 2019
Abstract Haemodynamic monitoring before extra-corporeal membrane oxygenation (ECMO) might help to optimize the effectiveness of ECMO. However, there are concerns that pulmonary arterial and trans-pulmonary thermodilution (TPTD) might be confounded by a loss of indicator into the ECMO-circuit, resulting in an overestimation of volumetric parameters. Since there is a lack of data on indicator dilution techniques during ECMO, we compared TPTD-measurements before and during ECMO. TPTD-derived parameters before and after initiation of ECMO were compared in 14 intensive care unit-patients with veno-venous ECMO and TPTD-monitoring ( PiCCO®). Eight patients had a jugular and six patients a femoral central venous catheter (CVC). Cardiac index, global end-diastolic volume index (GEDVI) and extra-vascular lung water index (EVLWI) before ECMO as well as the ECMO-flow were comparable in patients with jugular and femoral CVC. Pre-ECMO, cardiac index (CI) was not significantly different compared to values during ECMO (4.5 ± 1.7 vs. 4.4 ± 2.1 L/min/m2; p = 0.43). By contrast, GEDVI (791 ± 179 vs. 974 ± 384 mL/m2; p = 0.04) and EVLWI (21 ± 9 vs. 28 ± 11 mL/kg; p
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