VA ECMO Increases Afterload

This infographic illustrates the hemodynamic effects of VA ECMO (veno-arterial extracorporeal membrane oxygenation) on left ventricular performance, focusing on the pressure-volume (P-V) loop and the implications of increased afterload.

• P-V Loop at Different ECMO Flows
  The diagram shows how higher ECMO flow rates increase afterload, limiting left ventricular ejection. This leads to reduced stroke volume and elevated LV end-diastolic volume (LVEDV) and LV end-diastolic pressure (LVEDP). As afterload rises, the aortic valve opens less frequently and for shorter durations.
• Consequences of Increased LVEDP
  • Pulmonary edema: Increased LVEDP raises the risk of pulmonary congestion and worsens systemic oxygenation, contributing to North-South syndrome.
  • Myocardial ischemia: Reduced coronary perfusion impairs LV recovery, increasing the risk of myocardial injury.
  • Aortic valve complications: Limited aortic valve opening can cause thrombosis due to stasis. The presence of aortic regurgitation worsens the issue by further increasing LV preload.

The key takeaway is that titrating ECMO flow is crucial to balancing systemic perfusion and preventing adverse cardiac effects. Excessively high ECMO flow can lead to complications like pulmonary edema, coronary ischemia, and thrombotic events, complicating patient recovery.

Produced by: Dr. Karan Desai

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