Temporal Hemodynamic Patterns in Cardiogenic Shock Treated with Isolated PVAD and Combined Therapy with VA-ECMO

• In patients with cardiogenic shock undergoing temporary mechanical circulatory support (MCS), hemodynamic trends differed between patients with isolated microaxial flow pump (mAFP) and additional mAFP on VA-ECMO. • Patients with isolated mAFP showed progressive declines in atrial pressures, achieving >10 mmHg reduction in pulmonary artery wedge pressure (PAWP) and 5 mmHg in right atrial pressure. However, improvement patterns in hemodynamic indices were not different between survivors and non-survivors. • Patients receiving additional mAFP on VA-ECMO demonstrated rapid increases in cardiac output (CO PAC ), CPO, API, and MPS during the weaning phase of temporary MCS, along with reductions in PAWP and RAP. In survivors, additional improvements in PAWP and diastolic pulmonary arterial pressure (DPAP) were observed after VA-ECMO explantation. • Temporal trends in arterial pressures and functional indices may help to assess the degree of functional recovery during temporary MCS in patients receiving combination therapy. In patients with cardiogenic shock undergoing temporary mechanical circulatory support (MCS), hemodynamic trends differed between patients with isolated microaxial flow pump (mAFP) and additional mAFP on VA-ECMO. Patients with isolated mAFP showed progressive declines in atrial pressures, achieving >10 mmHg reduction in pulmonary artery wedge pressure (PAWP) and 5 mmHg in right atrial pressure. However, improvement patterns in hemodynamic indices were not different between survivors and non-survivors. Patients receiving additional mAFP on VA-ECMO demonstrated rapid increases in cardiac output (CO PAC ), CPO, API, and MPS during the weaning phase of temporary MCS, along with reductions in PAWP and RAP. In survivors, additional improvements in PAWP and diastolic pulmonary arterial pressure (DPAP) were observed after VA-ECMO explantation. Temporal trends in arterial pressures and functional indices may help to assess the degree of functional recovery during temporary MCS in patients receiving combination therapy. This study aimed to describe hemodynamic trends in patients with cardiogenic shock who received either isolated microaxial flow pump (mAFP) or additional mAFP on venoarterial extracorporeal membrane oxygenation support (i.e., ECMO+mAFP). Trends were also analyzed by hospital survival in each group. Using mixed-effect models, hemodynamic indices were analyzed from pre-, post-, and 24 hours after mAFP installation to immediately before device explantation in patients from the UNLOADERS-PVAD Registry, a Japanese multicenter registry of cardiogenic shock receiving mAFP. Hemodynamic indices from 409 patients (mean age 67 years, 75% male; 206 with isolated mAFP and 203 with ECMO+mAFP) were analyzed. From immediately before mAFP installation to immediately before mAFP explantation, the mAFP group achieved an 11.8 mmHg decrease in pulmonary artery wedge pressure (PAWP), a 5.8 mmHg decrease in right atrial pressure, and a 1.32 L/min increase in cardiac output (CO PAC ). Similarly, the ECMO+mAFP group showed a 2.8 L/min and 0.4 W increase in CO PAC and cardiac power output (CPO), respectively. Changing patterns of hemodynamic indices were comparable between survivors and non-survivors with isolated mAFP support. In the ECMO+mAFP group, survivors demonstrated additional increases in CO PAC , aortic pulsatility index, and myocardial performance score, and reductions in PAWP and diastolic pulmonary arterial pressure after VA-ECMO explantation. Patients with mAFP for cardiogenic shock exhibited progressive decreases in atrial pressures and increases in cardiac output, with distinct patterns in survivors receiving mAFP in addition to VA-ECMO. Hemodynamic monitoring may help determine the extent of cardiac recovery during combination therapy. Visual Take Home Graphic. Longitudinal collection of hemodynamic indices and temporal change during mAFP support.