Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is essential for circulatory maintenance for severe cardiogenic shock (CS) conditions. However, increased left ventricular (LV) loading and the subsequent exacerbation of pulmonary congestion remain major management challenges, particularly in severe depressed LV function. Recently, the concomitant use of a percutaneous LV assist device (Impella®), so-called ECPELLA therapy, has emerged as a potential solution to this clinical challenge. However, stable management of Impella remains challenging, as clinicians must coordinate two mechanical pumps under rapidly and profoundly changing hemodynamic conditions. We have developed an automated Impella (AIMOUS) system that induces LV unloading and stable hemodynamics for ECPELLA. This system automatically regulates pump speed to maintain the LV pressure through a negative feedback control mechanism of pump flow targeting LV pressure. Objective: The objective of this study was to evaluate the LV unloading accuracy and operational stability of AIMOUS combined with VA-ECMO in a goat model of severe CS. Methods: We used 4 goats (53.5±4.7 kg). We induced CS by micro-embolization of the left coronary arteries, maintained stable hemodynamics under VA-ECMO, and inserted Impella 5.5 via the left carotid artery. In Protocol 1 (n=4), we verified the responsiveness and LV pressure control accuracy of AIMOUS in the ECPELLA CS model. In Protocol 2 (n=2), we evaluated the system's regulation performance in response to stepwise increases in VA-ECMO. Results: In Protocol 1, under VA-ECMO conditions, AIMOUS reached the target LV systolic pressure (LVSP) of 40 mmHg within 51 ± 8 seconds after startup. During the subsequent 30-minute stabilization period, AIMOUS maintained LVSP within the target range (±20%) for 98.0 ± 3.7% of the time. In Protocol 2, despite stepwise increases in ECMO flow that induced fluctuations in preload and afterload of LV, AIMOUS promptly adjusted to these changes and maintained LVSP within the target range (±20%) with an achievement rate of 97.2 ± 3.4%. Conclusion: AIMOUS provides stable left ventricular unloading during VA-ECMO support. However, further long-term studies are required to establish its clinical usability. This abstract was presented at the American Physiology Summit 2026 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.
Taisei et al. (Fri,) studied this question.
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