Acute cardiac care & resuscitation
Hemodynamic Effects of Reducing Left Ventricular (LV) Afterload With Impella or Intra-Aortic Balloon Counterpulsation During Veno-Arterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock: HERACLES Trial
Authors' conclusion
In VA-ECMO supported SCAI D/E cardiogenic shock, IABP improved myocardial oxygen supply-demand balance, whereas mAFP did not. Further research is needed to determine whether these mechanistic differences translate to clinical outcomes.
Study context
- Population
- Patients receiving veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shockpatients enrolled
- Participants
- 24 patients
- Comparison
- LV unloading with intra-aortic balloon pump (IABP) vs micro-axial flow pump (mAFP) during VA-ECMO
- Primary endpoint
- Change in myocardial oxygen supply-demand ratio [(Tmn * TTI*HR)off / (Tmn * TTI *HR)unload]
Methodological detailsstratified by ischemic/non-ischemic etiology
- Stratified by ischemic/non-ischemic etiology
Primary result
As reported in the abstract
IABP
1.48
IQR 1.23–2.10
mAFP
0.97
IQR 0.92–1.39
P = 0.036
Secondary outcomes
Thirty-day mortality · 30 days · similar
P = 0.84
Device flow ratio (DFR)
| Outcome | IABP | mAFP |
|---|---|---|
| Coronary flow (DFR) | 1.16 (range in brackets 1.00–1.51) | 1.00 (range in brackets 0.86–1.13) |
Coronary flow (DFR)
- Coronary pressure increased but flow was unchanged with mAFP; coronary flow increased marginally with IABP
LV pressures and contractility
- LV pressures decreased with both devices and contractility with IABP only, with no between-group differences
Original publication
Hemodynamic Effects of Reducing LV Afterload With Impella or Intra-Aortic Balloon Counterpulsation During Veno-Arterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock: HERACLES Trial. Circ Cardiovasc Interv. Published 31 October 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →