VA-ECMO increases myocardial perfusion but does not promote myocardial recovery. Blood is pumped retrograde into the aortic root against a poorly functioning LV, resulting in increased LV filling pressures and LV afterload. This is worsened in peripheral VA-ECMO as the oxygenated blood is delivered retrogradely from the femoral artery, which supplies the least oxygenated blood to the coronary arteries. LV filling pressures can be reduced by improving contractility, inserting an IABP, or inserting an Impella.

References

• Mazzeffi MA, Rao VK, Del Rio JM, et al. Intraoperative management of adult patients on extracorporeal membrane oxygenation: an expert consensus statement from the society of cardiovascular anesthesiologists—part I, technical aspects of extracorporeal membrane oxygenation. J Cardiothorac Vasc Anesth. 2021;35:3496-3512.