Related Experiment Video
Updated: Mar 29, 2026
Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
Hemodynamic Effects of Adjunct Intra-Aortic Balloon Pumping During Veno-Arterial ECMO: A Pressure-Volume Loop Study
Giulio M Mondellini1, Myrthe P J van Steenwijk2, Jesse R Kimman2
1Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus Medical Center, Rotterdam, the Netherlands.
Background:
Severe ventriculo-arterial decoupling during veno arterial-extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock (CS) can be mitigated by adjunct intra-aortic balloon pump (IABP) support. The precise hemodynamic effects of IABP in this setting are however unknown.
Early Report Summary:
This case report describes in vivo left ventricular (LV) and right ventricular (RV) pressure-volume (PV) relationships in a young patient on VA-ECMO for CS after out-of-hospital cardiac arrest due to an ST-segment elevation myocardial infarction during a sequential IABP on-off-on protocol, at both low- and high-VA-ECMO flow states.
Discussion:
Using intracardiac PV loops at the time of VA-ECMO weaning in a patient with refractory CS, we demonstrated that adjunctive IABP: 1) reduced LV and RV afterload; 2) increased native stroke volume; and 3) in the low-flow setting only, coincided with a marked decrease in biventricular end-diastolic pressure.
Take-Home Message:
In our patient, invasive PV loop analyses showed that IABP support reduced LV and RV afterload during high-flow V-A ECMO and decreased preload of both ventricles at low VA-ECMO flow.
