The haemodynamic effects veno-arterial extracorporeal membrane oxygenation (VA-ECMO) remain inadequately understood. We investigated invasive left ventricular (LV) haemodynamics in patients who underwent treatment with an intensive care strategy involving extracorporeal cardiopulmonary resuscitation (ECPR).

We conducted invasive haemodynamic assessments on 15 patients who underwent ECPR and achieved return of spontaneous circulation. Left ventricular end-diastolic pressure (LVEDP), ejection fraction (LVEF), end-diastolic volume (LVEDV), and stroke work (LVSW) were evaluated using simultaneous invasive left heart catheterization and 3D echocardiography. Paired comparisons between high and low VA-ECMO flow were performed. Metrics were also compared between survivors and non-survivors.

Invasive haemodynamic studies were performed in 15 patients aged 58 (43,65) years at 3.0 (2.0, 4.0) days after cannulation. Six patients survived the index hospitalization, and 9 expired during the index hospitalization. Among the total cohort, transitioning from the highest VA-ECMO flow (median 4.0L/min) to the lowest VA-ECMO flow (median 2.0 L/min) led to increases in LVEDV from 85 (68,125) mL to 106 (70,153) mL (p=0.005) and LVEDP from 14 (8,23) mmHg to 17 (12,30) mmHg (p=0.001), respectively. Similarly, the LVSW increased from 2051±1525 mL*mmHg at the highest level of VA-ECMO flow to 2627±1559 at the lowest VA-ECMO flow (p=0.01). Although all patients had directionally similar changes, patients who survived the index hospitalization had higher LVEF at the lowest VA-ECMO flow and lower LVEDV and LVEDP compared to patients who expired (all p<0.05).

High VA-ECMO flow significantly reduced LVEDP, LVEDV, and LVSW compared to low VA-ECMO flow, irrespective of survival status.