hemodynamic and pulmonary permeability characterization of hantavirus cardiopulmonary syndrome by transpulmonary thermodilution hantavirus cardiopulmonary syndrome hcps is characterized by capillary leak pulmonary edema pe and shock which leads to death in up to 40 of patients treatment is supportive including mechanical ventilation mv and extracorporeal membrane oxygenation ecmo hemodynamic monitoring is critical to titrate therapy and to decide ecmo support transpulmonary thermodilution tptd provides hemodynamic and pe data that have not been systematically used to understand hcps pathophysiology we identified 11 hcps patients monitored with tptd eight on mv three required ecmo we analyzed 133 measurements to describe the hemodynamic pattern and its association with pe the main findings were reduced stroke volume global ejection fraction gef and preload parameters associated with increased extravascular lung water and pulmonary vascular permeability compatible with hypovolemia myocardial dysfunction and increased permeability pe lung water correlated positively with heart rate hr r 020 and negatively with mean arterial pressure r 027 and gef r 036 suggesting that pe is linked to hemodynamic impairment pulmonary vascular permeability correlated positively with hr r 031 and negatively with cardiac index r 049 enddiastolic volume r 048 and gef r 040 suggesting that capillary leak contributes to hypovolemia and systolic dysfunction in conclusion tptd data suggest that in hcps patients increased permeability leads to pe hypovolemia and circulatory impairment