Improved Microcirculation with Pulsatile Veno-Arterial ECMO: An Ovine Model of Cardiogenic Shock

Silver Heinsar, Kei Sato, Nchafatso Obonyo, Samia M Farah, Mahe Bouquet, Margaret R Passmore, Keibun Liu, Shinichi Ijunin, Carmen Ainola, Gianluigi Li Bassi, Jacky Y Suen, and John Fraser. AJRCCM DOI https://doi.org/10.1164/rccm.202402-0419LE

Background: In patients with severe refractory cardiogenic shock (CS), mechanical circulatory support is recommended by guidelines to restore critical end-organ perfusion. Despite increasing utilization, survival of veno-arterial extracorporeal membrane oxygenation (V-A ECMO) patients remains dismal at 45% and no randomized clinical trial has shown improved patient outcomes relative to other strategies. Multiorgan dysfunction remains the primary cause of death in CS supported by V-A ECMO, intensified by a systemic inflammatory response which exacerbates microcirculatory dysfunction.