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Canadian Journal of Cardiology

Contemporary Comprehensive Monitoring of Veno-arterial Extracorporeal Membrane Oxygenation Patients

Published:November 04, 2019DOI:https://doi.org/10.1016/j.cjca.2019.10.031

      Abstract

      The use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) has increased substantially over the past few decades. Today’s clinicians now have a powerful means with which to salvage a growing population of patients at risk for cardiopulmonary collapse. At the same time, patients supported with VA ECMO have become increasingly more complex. The successful use of VA ECMO depends not only on selecting the appropriate patients, but also on effectively navigating a potential torrent of device- and patient-related complications until ECMO is no longer needed. A multitude of monitoring tools are now available to help the treatment team determine the adequacy of care, to detect problems, and to anticipate recovery. Monitoring with devices such as the Swan-Ganz catheter, transthoracic and transesophageal echocardiography, chest radiography, and near-infrared spectroscopy can provide useful information to complement routine clinical care. Leveraging data derived from the ECMO circuit itself also can be instrumental in both evaluating the sufficiency of support and troubleshooting complications. Each of these tools, however, has its own unique sets of limitations and liabilities. A thorough understanding of these risks and benefits is critical to the contemporary care of the individual managed with VA ECMO. In addition, more research is needed to establish optimal evidence-based care pathways and best-practice principles for using these devices to improve patient outcomes.

      Résumé

      Depuis quelques décennies, on a de plus en plus souvent recours à l’oxygénation extracorporelle veino-artérielle par membrane (ECMO-VA). De nos jours, les cliniciens ont à leur disposition des moyens puissants qui leur permettent de sauver un nombre croissant de patients exposés à un risque de collapsus cardiopulmonaire. Parallèlement, les cas des patients assistés par ECMO-VA sont de plus en plus complexes. La réussite de l’intervention d’ECMO-VA dépend non seulement de la sélection d’un patient bon candidat, mais aussi de l’efficacité de la navigation à travers les très nombreuses complications, liées tant au dispositif qu’au patient, qui peuvent survenir jusqu’à ce que l’ECMO ne soit plus nécessaire. Il existe aujourd’hui une multitude d’outils de surveillance pour aider l’équipe soignante à évaluer la pertinence des soins, à détecter les problèmes et à anticiper le rétablissement. La surveillance au moyen de dispositifs comme le cathéter de Swan-Ganz, l’échocardiographie transthoracique et transœsophagienne, la radiographie thoracique et la spectroscopie proche infrarouge peut fournir des renseignements utiles en complément des soins cliniques habituels. Les données dérivées du circuit d’ECMO lui-même peuvent aussi jouer un rôle déterminant dans l’évaluation de l’adéquation de l’assistance et dans la résolution des complications. Chacun de ces outils comporte toutefois ses propres limites et risques. Une compréhension approfondie des risques et des avantages des outils employés est essentielle pour prodiguer des soins actuels aux patients pris en charge par ECMO-VA. En outre, d’autres études sont nécessaires pour établir des pratiques exemplaires et des parcours de soins optimaux fondés sur des données probantes à l’égard de l’emploi de ces dispositifs afin d’améliorer les résultats pour les patients.
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