Fig. 2
The impact of aortic pressure on ECPELLA-supported PV loop. In cardiogenic shock condition (A), VA-ECMO markedly increases total systemic flow, while loading LV and increasing PVA (B). Addition of Impella to VA-ECMO decreases PVA (C). Further addition of a vasodilator that decreases blood pressure further reduces PVA markedly, and further increases total systemic flow (D). The simulation was conducted using our electrical model reported previously [33]. The cardiovascular parameters employed for the simulation are depicted in the right column. MCS mechanical circulatory support, VA-ECMO venoarterial extracorporeal membrane oxygenation, ECPELLA combination of VA-ECMO and Impella, AOP aortic pressure, LAP left atrial pressure, LVP left ventricular pressure, LVCO left ventricular cardiac output, PV pressure‒volume, PVA pressure‒volume area, LV-Ees left ventricular end-systolic elastance, RV-Ees right ventricular end-systolic elastance, EDPVR end-diastolic pressure–volume relationship, V0 the volume intercept of end-systolic pressure volume relationship of LV, SBV stressed blood volume, SVR systemic vascular resistance, PVR pulmonary vascular resistance