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Updated: Jun 14, 2026

Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
Hemodynamic-guided V-A ECMO management for cardiogenic shock: Insight from initial experience from TWEET study (to
Angelo Nascimbene1, Sinan Tosun1, Sriram Nathan1
1Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
None:
BackgroundVeno-arterial extracorporeal membrane oxygenation (V-A ECMO) is used for refractory cardiogenic shock, yet optimal weaning strategies and the role of left ventricular (LV) venting remain unclear. The TWEET-1 study was designed as an early feasibility investigation to define processes, timelines, and clinical parameters for future interventional trials evaluating Impella 5.5 for LV venting during V-A ECMO support.MethodsThis prospective, single-center observational study from 2021 to 2025 included patients who received standard-of-care V-A ECMO and Swan-Ganz monitoring. Patients were assigned to the ECPELLA + group (defined as the addition of Impella 5.5 to V-A ECMO to provide left ventricular unloading) when pulmonary artery (PA) diastolic pressure exceeded 20 mm Hg; other individuals served as controls. The primary outcome was survival to discharge. Secondary outcomes included V-A ECMO duration, complications, and SAVE score-adjusted survival.ResultsAmong 117 screened patients, 43 were enrolled (25 ECPELLA +, 18 controls). Overall survival to discharge was 53% with no significant difference between groups. ECPELLA + patients had higher pulmonary pressures and longer V-A ECMO support but demonstrated appropriate selection for unloading. Both groups exceeded the SAVE score-predicted survival. Subgroup analysis suggested potential benefit of Impella venting in the most severe patients (SAVE -14 to -10).DiscussionHemodynamic-guided LV venting with Impella 5.5 during V-A ECMO was feasible and enabled prompt LV unloading (ECPELLA). While survival to discharge did not differ significantly between groups, patients with higher PA diastolic pressures and SAVE scores below -10 demonstrated a significant reduction in mortality with LV unloading.ConclusionEarly hemodynamic-guided LV unloading may improve risk-adjusted V-A ECMO outcomes.
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