**4. LV unloading during v-a ECLS employing IABP**

A combination of v-a ECLS with an intra-aortic balloon pump (IABP) can be applied for LV unloading. The use of IABP can decrease LV afterload during systole, increase diastolic blood pressure and coronary blood flow, and significantly improve survival in ECLS patients [5, 8]. However, since the publication of the IABP-SHOCK II Trial, where no survival benefit for IABP application in cardiogenic shock patients could be demonstrated, the use of IABP is decreasing [9]. The effect of the IABP on LV unloading depends on a degree of LV contractility—the less contractility, the less unloading [3]. Therefore, in patients for whom LV requires maximal unloading, the IABP does not work [9]. Nevertheless, IABP remains a feasible option for patients with mechanical aortic valves, since Impella unloading is technically not possible, and *Left Ventricular Unloading in v-a ECLS Patients DOI: http://dx.doi.org/10.5772/intechopen.106349*

passive LV unloading may preclude LV ejection and, therefore, carry a high risk for mechanical aortic valve thrombosis [10]. Further, in patients with mobile LV thrombus precluding Impella unloading, IABP remains a feasible alternative [10, 11].
