Fig. 6

Impact of ECPELLA on the right and left ventricular PV loops on BVF haemodynamics. Three conditions of MCS are shown: Impella alone (A), 2.0 mL/min of VA-ECMO with Impella (B), and 4.0 mL/min of VA-ECMO with Impella (C). Different conditions are represented by various colours (black line: baseline, yellow: supported with Impella P2, red: Impella P6). The PV loop changes were similar to the results of protocol 1. In higher VA-ECMO conditions, the increase in Impella support level markedly shifted both the RV- and LV-PV loops downward to the left. PV loop pressure–volume loop, BVF biventricular failure, MCS mechanical circulatory support, VA-ECMO veno-arterial extracorporeal membrane oxygenation, RVP right ventricular pressure, RVV right ventricular volume, LVP left ventricular pressure, LVV left ventricular volume