Acute cardiac care & resuscitation
Effect of Extracorporeal Membrane Oxygenation (ECMO) Flow Variations on Pulmonary Capillary Wedge Pressure in Patients With Cardiogenic Shock
Authors' conclusion
As VA-ECMO flow increases, the expected rise in PCWP caused by afterload elevation appears to be counterbalanced by a reduction in RV preload, resulting in a neutral effect in most patients, a significant PCWP decrease in approximately one-third, and an only infrequent increase.
Study context
- Population
- Patients with cardiogenic shock on femoro-femoral VA-ECMO, early phase after stabilization, Pitié-Salpêtrière Hospital, Paris, France
- Participants
- 80 patients
- Exposure
- Stepwise VA-ECMO flow variations from 2 to 4 L/min
- Outcome
- Impact of incremental VA-ECMO flow variations on PCWP
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
PCWP response during ECMO-Flow trial
Pulmonary capillary wedge pressure (PCWP) decreased
29 patients
36%
PCWP remained stable
46
58%
PCWP increased
5
6%
Observational data: associations, not effects.
Further findings
Baseline PCWP
- PCWP ≥18 mm Hg
- 27 patients (34%)
- Left ventricular (LV) dilation, mitral regurgitation, elevated central venous pressure (CVP) and preserved right ventricular (RV) function associated with higher baseline PCWP
Other hemodynamic parameters during ECMO-Flow trial
- CVP significantly decreased; RV afterload unchanged
- Indexed stroke volume decreased; myocardial work stable despite increased LV afterload
- Significant PCWP decrease in patients with better baseline LV and RV function and lower CVP
Original publication
Effect of ECMO Flow Variations on Pulmonary Capillary Wedge Pressure in Patients With Cardiogenic Shock. J Am Coll Cardiol. Published 16 September 2025. doi:10.
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