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 < 0.01) were higher during ECMO than before. Increases in GEDVI (36 ± 210 vs. 378 ± 247 mL/m2; p = 0.02) and EVLWI (3 ± 2 vs. 11 ± 8 mL/kg; p = 0.06) were substantially more pronounced in patients with femoral compared to jugular indicator injection. In multivariate analysis, femoral indicator injection was independently associated with larger increases in GEDVI (p < 0.01) and EVLWI (p = 0.04) during ECMO. However, CI and haemodynamic parameters not derived from TPTD, but from pulse contour analysis (systolic and diastolic arterial pressure, stroke volume variation and pulse pressure variation) were not affected by the start of ECMO. Our study demonstrates marked increases in GEDVI and EVLWI after the onset of ECMO. These increases were more pronounced for femoral compared to jugular indicator injection. CI and haemodynamic parameters not derived from TPTD were not affected by the extra-corporeal circuit.
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Acute respiratory distress syndrome
Pulmonary blood volume
Cardiac power index
Central venous catheter
Central venous pressure
Dynamic arterial elastance
Extra-corporeal membrane oxygenation
Extra-vascular lung water index
Global end-diastolic volume index
Intensive care unit
Loss of indicator
Mean transit time
Pulmonary arterial catheter
Pulse contour analysis
Pulmonary blood volume
Pulse pressure variation
Partial thromboplastin time
Pulmonary thermal volume
Pulmonary vascular permeability index
Randomized controlled trial
Stroke volume variation
Intra-thoracic thermal volume
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The authors received no specific funding for this work.
Conflict of interest
Wolfgang Huber collaborates with Pulsion Medical Systems SE, Feldkirchen, Germany as Member of the Medical Advisory Board. All other authors declare that they have no competing interests.
The Institutional Review Board approved the study (Ethikkommission; Fakultät für Medizin; Technische Universität München 310/18S).
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Herner, A., Lahmer, T., Mayr, U. et al. 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. J Clin Monit Comput 34, 923–936 (2020). https://doi.org/10.1007/s10877-019-00398-6
- Extra-corporeal membrane oxygenation
- Trans-pulmonary thermodilution
- Cardiac output
- Pulse contour analysis
- Global end-diastolic volume index
- Extra-vascular lung water index