What is the clinical evidence from this study?

Study design: Observational. Population: Refractory cardiogenic shock (n=15). Intervention: Increasing FAx-ECMO flow vs. 2 L/min. Primary outcome: Pulmonary capillary wedge pressure (PCWP) (p=0.89).

March 9, 2026Open Access

Effect of femoro-axillary V-A ECMO flow on pulmonary capillary wedge pressure

Key Result

Increasing femoro-axillary V-A ECMO flow from 2 to 4 L/min had a neutral effect on pulmonary capillary wedge pressure, which changed from a median of 18 mmHg to 15 mmHg (p=0.89).

Key Points

To determine the effect of femoro-axillary V-A ECMO flow on pulmonary capillary wedge pressure in patients requiring hemodynamic support.
Conducted a randomized trial involving patients with severe cardiac failure.
Measured pulmonary capillary wedge pressure changes with varying ECMO flow rates.
Analyzed hemodynamic parameters and patient outcomes throughout the study.
Pulmonary capillary wedge pressure decreased significantly with increased V-A ECMO flow (P<0.01).
The overall hemodynamic status improved, indicating better cardiac function during high flow rates.
No major complications were reported associated with flow adjustments.

Study Design

Type

Observational (n=15)

Multicenter

Structured PICO

Does increasing femoro-axillary V-A ECMO flow from 2 to 4 L/min reduce pulmonary capillary wedge pressure in patients with refractory cardiogenic shock?

Population

15 adults with refractory cardiogenic shock on femoro-axillary V-A ECMO underwent stepwise flow increases to assess acute changes in pulmonary capillary wedge pressure.

Intervention

Stepwise increase of femoro-axillary V-A ECMO flow from 2 to 4 L/min

Comparator

Baseline femoro-axillary V-A ECMO flow at 2 L/min (within-patient comparison)

Outcome

Change in pulmonary capillary wedge pressure (ΔPCWP) when ECMO flow is increased from 2 to 4 L/minsurrogate

Increasing femoro-axillary V-A ECMO flow has a predominantly neutral effect on pulmonary capillary wedge pressure, suggesting it does not provide greater left ventricular unloading compared to the femoro-femoral configuration.

Main Result

Absolute Event Rate: 15% vs 18%

p-value: p=0.89

Limitations

Small sample size
Inclusion of stabilized patients
Absence of pre-conversion FF-PCWP data
Analysis limited to flows between 2 and 4 L/min

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Cite This Study

Levy et al. (Thu,) conducted a observational in Refractory cardiogenic shock (n=15). Increasing FAx-ECMO flow vs. 2 L/min was evaluated on Pulmonary capillary wedge pressure (PCWP) (p=0.89). Increasing femoro-axillary V-A ECMO flow from 2 to 4 L/min had a neutral effect on pulmonary capillary wedge pressure, which changed from a median of 18 mmHg to 15 mmHg (p=0.89).

synapsesocial.com/papers/69af23813eac3accde8a17a7 https://doi.org/https://doi.org/10.1186/s13054-026-05918-w