Head-to-head comparison of central and peripheral venoarterial ECMO in normal ovine hearts and in cardiogenic shock

Abstract

Venoarterial extracorporeal membrane oxygenation (VA ECMO) is a temporary mechanical circulatory support employed with either central (cECMO) or peripheral (pECMO) cannulation. Reports of detailed invasive monitoring of patients on VA ECMO for cardiogenic shock are limited due to ethical limitations. The differences between cECMO and pECMO on mechano-energetics in normal hearts and in cardiogenic shock has not been quantified in detail. In this open chest acute ovine model of alternate cECMO and pECMO, no overall differences were seen between the two in either normal or shock states where acute cardiogenic shock was produced by intra-myocardial ethanol injection. Haemodynamic and mechano-energetic responses to VA ECMO support differed between normal and shock states. VA ECMO increased blood pressure and total systemic flow more so in shock than in normal hearts but the left ventricular (LV) unloading was attenuated in shock. The decreases in LV stroke work (SW) and myocardial oxygen consumption (MVO2) were significant, with preserved SW to MVO2 ratios in both conditions.