Phenotyping hemodynamic response to veno-arterial extracorporeal membrane oxygenation in cardiogenic shock

Simulation models suggest that veno-arterial extracorporeal membrane oxygenation (VA ECMO) uniformly results in left ventricular (LV) distension in cardiogenic shock (CS). This study characterized the hemodynamic response to VA ECMO in animal models of CS, and in patients with CS. LV end-diastolic pressure (LVEDP) and arterial pulse pressure (PP) were assessed in 58 pigs with CS at 2 levels of VA ECMO flows. Pulmonary artery diastolic pressure (PADP), PA pulse pressure (PAPP), and arterial PP data were collected within 2 h of VA ECMO from 128 patients with CS. The animal study identified 3 phenotypes. The centroids of LVEDP and arterial PP changes for Cluster 1 were +4.99 and -1.85 mmHg, Cluster 2 +0.02 and -5.57 mmHg, and Cluster 3 +1.31 and +15.5 mmHg. The clinical study identified 3 phenotypes: "pulsatile" phenotype (26%, highest arterial PP), "low pulsatility" phenotype (52%, low arterial PP and PAPP), and "LV distension" phenotype (22%, elevated PADP). Acute MI was more common in the "LV distension" phenotype. The "low pulsatility" phenotype had a larger RV diameter and tricuspid regurgitation. In summary, this study identified three hemodynamic phenotypes early post-VA ECMO that were related to the underlying CS etiology and RV function.