Figure 3.

Pressure–volume loop analysis of both afterload and blood volume reduction in left ventricular (LV) systolic failure supported by veno-arterial extracorporeal membrane oxygenation (VA ECMO) 4 L/min. Blood volume is reduced by 800 mL reaching a normal blood volume. Afterload (systemic vascular resistance) is then reduced until mean arterial blood pressure (MAP) reaches 65 mm Hg, as shown in Figure 2. Stroke volume and end-diastolic volume is reduced as compared with afterload reduction alone, thereby illustrating the importance of blood volume reduction in LV unloading.