Impact of Venoarterial Extracorporeal Membrane Oxygenation on Hemodynamics and Cardiac Mechanics: Insights From Pressure-Volume Loop Analysis

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) serves as a critical mechanical circulatory support modality, sustaining systemic circulation in cases of severe cardiac failure or cardiac arrest. While VA-ECMO improves hemodynamics, it markedly increases left ventricular (LV) afterload, c...

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Published inInternational journal of heart failure Vol. 7; no. 3; pp. 125 - 138
Main Authors Otake, Masahiro, Morita, Hidetaka, Sato, Kei, Saku, Keita
Format Journal Article
LanguageEnglish
Published Korea (South) Korean Society of Heart Failure 01.07.2025
대한심부전학회
Subjects
Review
내과학
Heart failure
Physiology
Hemodynamics
In silico modeling
Venoarterial extracorporeal membrane oxygenation
Online AccessGet full text
ISSN2636-154X
2636-1558
2636-1558
DOI10.36628/ijhf.2025.0005

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Abstract Venoarterial extracorporeal membrane oxygenation (VA-ECMO) serves as a critical mechanical circulatory support modality, sustaining systemic circulation in cases of severe cardiac failure or cardiac arrest. While VA-ECMO improves hemodynamics, it markedly increases left ventricular (LV) afterload, contributing to pulmonary congestion and thrombus formation. This review highlights the hemodynamic and mechanical effects of VA-ECMO, employing the pressure-volume (PV) loop and the generalized circulatory equilibrium model. The PV loop framework clarifies how VA-ECMO elevates afterload, potentially reducing stroke volume and the cardiac output curve when LV contractility is severely impaired. Similarly, the generalized circulatory equilibrium concept illustrates how VA-ECMO shifts the circulatory equilibrium point in both ventricles. These models establish a mechanistic foundation for strategies combining VA-ECMO with other devices, such as an intra-aortic balloon pump, Impella, or central VA-ECMO equipped with LV venting. Based on these frameworks, appropriate patient selection, effective device management, and integration with LV unloading devices may enhance survival in patients requiring VA-ECMO.
AbstractList Venoarterial extracorporeal membrane oxygenation (VA-ECMO) serves as a critical mechanical circulatory support modality, sustaining systemic circulation in cases of severe cardiac failure or cardiac arrest. While VA-ECMO improves hemodynamics, it markedly increases left ventricular (LV) afterload, contributing to pulmonary congestion and thrombus formation. This review highlights the hemodynamic and mechanical effects of VA-ECMO, employing the pressure-volume (PV) loop and the generalized circulatory equilibrium model. The PV loop framework clarifies how VA-ECMO elevates afterload, potentially reducing stroke volume and the cardiac output curve when LV contractility is severely impaired. Similarly, the generalized circulatory equilibrium concept illustrates how VA-ECMO shifts the circulatory equilibrium point in both ventricles. These models establish a mechanistic foundation for strategies combining VA-ECMO with other devices, such as an intra-aortic balloon pump, Impella, or central VA-ECMO equipped with LV venting. Based on these frameworks, appropriate patient selection, effective device management, and integration with LV unloading devices may enhance survival in patients requiring VA-ECMO.Venoarterial extracorporeal membrane oxygenation (VA-ECMO) serves as a critical mechanical circulatory support modality, sustaining systemic circulation in cases of severe cardiac failure or cardiac arrest. While VA-ECMO improves hemodynamics, it markedly increases left ventricular (LV) afterload, contributing to pulmonary congestion and thrombus formation. This review highlights the hemodynamic and mechanical effects of VA-ECMO, employing the pressure-volume (PV) loop and the generalized circulatory equilibrium model. The PV loop framework clarifies how VA-ECMO elevates afterload, potentially reducing stroke volume and the cardiac output curve when LV contractility is severely impaired. Similarly, the generalized circulatory equilibrium concept illustrates how VA-ECMO shifts the circulatory equilibrium point in both ventricles. These models establish a mechanistic foundation for strategies combining VA-ECMO with other devices, such as an intra-aortic balloon pump, Impella, or central VA-ECMO equipped with LV venting. Based on these frameworks, appropriate patient selection, effective device management, and integration with LV unloading devices may enhance survival in patients requiring VA-ECMO.
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) serves as a critical mechanical circulatory support modality, sustaining systemic circulation in cases of severe cardiac failure or cardiac arrest. While VA-ECMO improves hemodynamics, it markedly increases left ventricular (LV) afterload, contributing to pulmonary congestion and thrombus formation. This review highlights the hemodynamic and mechanical effects of VA-ECMO, employing the pressure-volume (PV) loop and the generalized circulatory equilibrium model. The PV loop framework clarifies how VA-ECMO elevates afterload, potentially reducing stroke volume and the cardiac output curve when LV contractility is severely impaired. Similarly, the generalized circulatory equilibrium concept illustrates how VA-ECMO shifts the circulatory equilibrium point in both ventricles. These models establish a mechanistic foundation for strategies combining VA-ECMO with other devices, such as an intra-aortic balloon pump, Impella, or central VA-ECMO equipped with LV venting. Based on these frameworks, appropriate patient selection, effective device management, and integration with LV unloading devices may enhance survival in patients requiring VA-ECMO.
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) serves as a critical mechanical circulatory support modality, sustaining systemic circulation in cases of severe cardiac failure or cardiac arrest. While VA-ECMO improves hemodynamics, it markedly increases left ventricu- lar (LV) afterload, contributing to pulmonary congestion and thrombus formation. This review highlights the hemodynamic and mechanical effects of VA-ECMO, employing the pressure-vol- ume (PV) loop and the generalized circulatory equilibrium model. The PV loop framework clarifies how VA-ECMO elevates afterload, potentially reducing stroke volume and the cardiac output curve when LV contractility is severely impaired. Similarly, the generalized circulatory equilibrium concept illustrates how VA-ECMO shifts the circulatory equilibrium point in both ventricles. These models establish a mechanistic foundation for strategies combining VA-ECMO with other devices, such as an intra-aortic balloon pump, Impella, or central VA-ECMO equipped with LV venting. Based on these frameworks, appropriate patient selection, effective device man- agement, and integration with LV unloading devices may enhance survival in patients requiring VA-ECMO. KCI Citation Count: 0
Author Sato, Kei
Morita, Hidetaka
Saku, Keita
Otake, Masahiro
AuthorAffiliation 2 Bio Digital Twin Center, National Cerebral and Cardiovascular Center, Osaka, Japan
1 Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Suita, Japan
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Issue 3
Keywords Heart failure
Physiology
Hemodynamics
In silico modeling
Venoarterial extracorporeal membrane oxygenation
Language English
License Copyright © 2025. Korean Society of Heart Failure.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Snippet Venoarterial extracorporeal membrane oxygenation (VA-ECMO) serves as a critical mechanical circulatory support modality, sustaining systemic circulation in...
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Title Impact of Venoarterial Extracorporeal Membrane Oxygenation on Hemodynamics and Cardiac Mechanics: Insights From Pressure-Volume Loop Analysis
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