Table 7. pVAD monitoring.
| Variable | Advantages | Limitations |
| Echocardiography | ||
| Ventricular size | End-diastolic volume (EDV) | Difficult to assess for RV, may vary depending on the level of support |
| Ejection fraction LV velocity time integral Pre ejection and total ejection time |
Global assessment of LV function – Estimation of LV stroke volume/CO – Integrated with LVEF allow the assessment of Ees |
– Load and heart rate dependent – Less indicative in case of asynchrony – Aortic stenosis – Angle dependent – Not validated in cardiogenic shock |
| MAPSE/TAPSE | Early and sensitive for systolic function | Annular abnormalities |
| Tissue Doppler velocity; strain/strain rate | Early and sensitive for systolic and diastolic function | Require high skill and further validation |
| Valvular abnormalities | – Indirect evaluation of ventricular function (dP/dT; TAPSE/sPAP) – Ventricular offloading (MR) Dependent by alignment – Right side pressures (sPAP, dPAP) |
– TOE is more sensitive – Dependent by alignment |
| Haemodynamic and respiratory | ||
| Pulse-oximetry | Continuous monitoring of peripheral oxygen saturation | – To be placed on the right arm in ECMO patients – Dependent on skin conditions – Arterial flow pulsatility |
| Invasive blood pressure monitoring | – Systemic blood pressure – Oxygenation/metabolic profile (pH, paO2, paCO2, base excess, meta-haemoglobin) – Lactate – Haemoglobin |
– Right radial artery is more representative of coronary and upper body oxygenation – To be taken before full regimen anticoagulation |
| Pulmonary artery catheter | – Pulmonary (sPAP, dPAP, mPAP) and right atrial pressures – SVR/PVR – Left ventricular capillary wedge pressure – CO/CI – PAPi – CPO – SvO2 – Pa-vCO2 |
– To be taken prior of full regimen anticoagulation – SvO2 inaccurate in VA-ECMO and TandemHeart patients due to the venous component of the blood coming from the native pulmonary circulation |
| Conductance catheter | V-A coupling | Not validated in cardiogenic shock |
| Non-invasive monitoring | ||
| Near-infrared spectroscopy (NIRS) | – Easy values to interpret – Regional oxyhaemoglobin saturation (rSO2) – Perfusion of the distal limb |
– No absolute numbers, but the trend of the values – Individual Hb level and variations in cerebral venous/arterial blood ratio – Needs confirmation with ultrasound |
| Optical nerve shear diameter | Indirect evaluation of intracranial pressure | Needs validation in this setting |
| Coagulation monitoring | ||
| Activated clotting time | – Easy and bedside – Widely available and sensitive |
High variability and non-specificity for heparin |
| aPTT | – Easy and bedside – Widely available and sensitive |
High variability and non-specificity for heparin |
| Anti-Xa | Sensitive to heparin function | Not widely available |
| Cardiac-specific markers | ||
| BNP, NT-pro-BNP | Ventricle overload | – No absolute numbers, but the trend of the values – No specific validation in this setting |
| hs-TnI | Rise/fall sensitive for myocardial ischaemia | – No absolute numbers, but the trend of the values – No specific validation in this setting |
| aPTT: activated partial thromboplastin time; BNP: B-type natriuretic peptide; CI: cardiac index; CO: cardiac output; CPO: cardiac power output; CRP: C-reactive protein; dPAP: diastolic pulmonary artery pressure; Ees: end-systolic elastance; hs-TnI: high-sensitivity troponin I; LV: left ventricle; LVEF: left ventricular ejection fraction; MAPSE: mitral annular plane systolic excursion; mPAP: mean pulmonary artery pressure; MR: mitral regurgitation; PAPi: pulmonary artery pulsatility index; PVR: pulmonary vascular resistance; RV: right ventricle; sPAP: systolic pulmonary artery pressure; SVR: systolic vascular resistance; TAPSE: tricuspid annular plane systolic excursion; TOE: transoesophageal echocardiography; V-A coupling: ventricular-arterial coupling; VA-ECMO: veno-arterial extracorporeal membrane oxygenation | ||