AimsVeno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) with profound left ventricular (LV) failure is associated with inadequate LV emptying. To unload the LV, VA‐ECMO can be combined with Impella CP (ECMELLA). We hypothesized that ECMELLA improves cardiac energetics compared with VA‐ECMO in a porcine model of cardiogenic shock (CS).Methods and resultsLand‐race pigs (weight 70 kg) were instrumented, including a LV conductance catheter and a carotid artery Doppler flow probe. CS was induced with embolization in the left main coronary artery. CS was defined as reduction of ≥50% in cardiac output or mixed oxygen saturation (SvO2) or a SvO2 < 30%. At CS VA‐ECMO was initiated and embolization was continued until arterial pulse pressure was <10 mmHg. At this point, Impella CP was placed in the ECMELLA arm. Support was maintained for 4 h. CS was induced in 15 pigs (VA‐ECMO n = 7, ECMELLA n = 8). At time of CS MAP was <45 mmHg in both groups, with no difference at 4 h (VA‐ECMO 64 mmHg ± 11 vs. ECMELLA 55 mmHg ± 21, P = 0.08). Carotid blood flow and arterial lactate increased from CS and was similar in VA‐ECMO and ECMELLA [239 mL/min ± 97 vs. 213 mL/min ± 133 (P = 0.6) and 5.2 ± 3.3 vs. 4.2 ± 2.9 mmol/ (P = 0.5)]. Pressure‐volume area (PVA) was significantly higher with VA‐ECMO compared with ECMELLA (9567 ± 1733 vs. 6921 ± 5036 mmHg × mL/min × 10−3, P = 0.014). Total diureses was found to be lower in VA‐ECMO compared with ECMELLA [248 mL (179–930) vs. 506 mL (418–2190); P = 0.005].ConclusionsIn a porcine model of CS, we found lower PVA, with the ECMELLA configuration compared with VA‐ECMO, indicating better cardiac energetics without compromising systemic perfusion.

中文翻译：

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VA-ECMO 与 VA-ECMO 加 Impella CP 对大型动物模型心源性休克的血流动力学影响

静脉动脉体外膜氧合 (VA-ECMO) 伴严重左心室 (LV) 衰竭与 LV 排空不足相关。为了卸载 LV，VA-ECMO 可以与 Impella CP (ECMELLA) 结合使用。我们假设，在心源性休克 (CS) 猪模型中，与 VA-ECMO 相比，ECMELLA 可以改善心脏能量。方法和结果对陆地赛猪（体重 70 kg）进行仪器测试，包括左心室电导导管和颈动脉多普勒血流探头。通过左冠状动脉主干栓塞诱导 CS。 CS定义为心输出量或混合氧饱和度（SvO2) 或 SvO2< 30%。在 CS 时，启动 VA-ECMO 并继续栓塞直至动脉脉压<10 mmHg。此时，Impella CP 被放置在 ECMELLA 臂中。支持维持4小时。在 15 头猪中诱导 CS（VA-ECMOn= 7、埃克梅拉n= 8）。在 CS 时，两组的 MAP 均<45 mmHg，4 小时后无差异（VA-ECMO 64 mmHg ± 11 与 ECMELLA 55 mmHg ± 21，磷= 0.08）。颈动脉血流量和动脉乳酸从 CS 中增加，并且在 VA-ECMO 和 ECMELLA 中相似 [239 mL/min ± 97 vs. 213 mL/min ± 133 (磷= 0.6) 和 5.2 ± 3.3 对比 4.2 ± 2.9 mmol/ (磷= 0.5)]。与 ECMELLA 相比，VA-ECMO 的压力容积面积 (PVA) 显着更高（9567 ± 1733 vs. 6921 ± 5036 mmHg × mL/min × 10−3,磷= 0.014）。与 ECMELLA 相比，VA-ECMO 的总利尿量较低 [248 mL (179–930) vs. 506 mL (418–2190)；磷= 0.005]。结论在 CS 猪模型中，我们发现与 VA-ECMO 相比，ECMELLA 配置的 PVA 较低，表明心脏能量更好，且不影响全身灌注。