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Background: The hemodynamic effects of femoro-femoral venoarterial (VA) extracorporeal membrane oxygenation (ECMO) on pulmonary capillary wedge pressure (PCWP) remain poorly defined. High ECMO flow is believed to increase PCWP and the risk of pulmonary edema; yet, supporting in vivo physiological data are lacking.
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Harlequin syndrome, also known as differential hypoxia (DH) or North-South syndrome, is a serious complication of femoro-femoral venoarterial extracorporeal membrane oxygenation (V-A ECMO). Moreover, Harlequin syndrome is caused by competing flows between the retrograde oxygenated ECMO output and the anterograde ejection of poorly oxygenated blood from the native heart. In the setting of impaired pulmonary gas exchange, the addition of an Impella device (ECPELLA configuration), although beneficial for ventricular unloading and hemodynamic support, may further exacerbate this competition and precipitate DH.
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