Extracorporeal Membrane Oxygenation Cannulation Site Affects Coronary and Cerebral Perfusion When Combined With...

The use of intra-aortic balloon pump (IABP) alongside venoarterial extracorporeal membrane oxygenation (VA-ECMO) in critically ill patients presenting refractory cardiogenic shock raises questions regarding its impact on organs perfusion. This in vitro study aimed to examine the combined effects of IABP and VA-ECMO on coronary, cerebral, and renal perfusion, particularly considering the choice of arterial cannulation site. A mock circuit with a pulsatile pump was used to simulate different scenarios with increasing severities of low cardiac output syndromes treated by concomitant IABP and VA-ECMO support. Flow rates were measured using ultrasonic flowmeters. Each scenario was tested with two different VA-ECMO outflow access sites: femoral and axillary arteries, at heart rates of 60 and 100 bpm. Results showed that concomitant use of IABP with VA-ECMO in the axillary artery increases more significantly cerebral and coronary flow rates compared to femoral access in intermediate and severe shock. Nevertheless, renal perfusion appeared to be more negatively affected in this configuration. In summary, employing IABP alongside axillary VA-ECMO enhances cerebral and coronary flow but may compromise renal perfusion. Shock severity, heart rate, and cannulation site should be considered for a tailored approach. Future investigations using sophisticated autoregulated systems are needed to confirm these observations.