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Since multiple cardiovascular and pump factors influence the haemodynamic effects of ECPELLA, optimising ECPELLA management remains challenging. In this study, we conducted a comprehensive simulation study of ECPELLA haemodynamics. We also simulated global oxygen delivery (DO\n                      <jats:sub>2<\/jats:sub>\n                      ) under ECPELLA in severe CS and acute respiratory failure as a first step to incorporate global DO\n                      <jats:sub>2<\/jats:sub>\n                      into our developed cardiovascular simulation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>\n                      Both the systemic and pulmonary circulations were modelled using a 5-element resistance\u2012capacitance network. The four ventricles were represented by time-varying elastances with unidirectional valves. In the scenarios of severe LV dysfunction, biventricular dysfunction with normal pulmonary vascular resistance (PVR, 0.8 Wood units), and biventricular dysfunction with high PVR (6.0 Wood units), we compared the changes in haemodynamics, pressure\u2013volume relationship (PV loop), and global DO\n                      <jats:sub>2<\/jats:sub>\n                      under different VA-ECMO flows and Impella support levels.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the simulation, ECPELLA improved total systemic flow with a minimising biventricular pressure\u2013volume loop, indicating biventricular unloading in normal PVR conditions. Meanwhile, increased Impella support level in high PVR conditions rendered the LV\u2013PV loop smaller and induced LV suction in ECPELLA support conditions. The general trend of global DO\n                      <jats:sub>2<\/jats:sub>\n                      was followed by the changes in total systemic flow. The addition of veno-venous ECMO (VV-ECMO) augmented the global DO\n                      <jats:sub>2<\/jats:sub>\n                      increment under ECPELLA total support conditions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      The optimal ECPELLA support increased total systemic flow and achieved both biventricular unloading. The VV-ECMO effectively improves global DO\n                      <jats:sub>2<\/jats:sub>\n                      in total ECPELLA support conditions.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40635-024-00599-7","type":"journal-article","created":{"date-parts":[[2024,2,15]],"date-time":"2024-02-15T20:21:45Z","timestamp":1708028505000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The impact of ECPELLA on haemodynamics and global oxygen delivery: a comprehensive simulation of biventricular failure"],"prefix":"10.1186","volume":"12","author":[{"given":"Hiroki","family":"Matsushita","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6856-9362","authenticated-orcid":false,"given":"Keita","family":"Saku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Nishikawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shohei","family":"Yokota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kei","family":"Sato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidetaka","family":"Morita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Yoshida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masafumi","family":"Fukumitsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazunori","family":"Uemura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toru","family":"Kawada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Yamaura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,16]]},"reference":[{"issue":"15","key":"599_CR1","doi-asserted-by":"publisher","first-page":"e021061","DOI":"10.1161\/JAHA.121.021061","volume":"10","author":"M Osman","year":"2021","unstructured":"Osman M, Syed M, Patibandla S, Sulaiman S, Kheiri B, Shah MK, Bianco C, Balla S, Patel B (2021) Fifteen-year trends in incidence of cardiogenic shock hospitalization and in-hospital mortality in the United States. 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As such, traditional ethics approval and consent were not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Matsushita H, Nishikawa T, Yokota S, Sato K, Morita H, Yoshida Y, Fukumitsu M, Uemura K, Kawada T, and Yamaura K have nothing to declare. Saku K received research funding from Abiomed, Inc.,\u00a0NTT Research, Inc., Asahi Kasei ZOLL Medical Corporation, Neuroceuticals Inc.,\u00a0and Zeon Medical Inc., and honoraria from Abiomed Japan K.K., Mallinckrodt Pharma K.K.,\u00a0and Ono Pharmaceutical Co., Ltd.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"13"}}