Veno-arterial (VA) extra-corporeal membrane oxygenation (ECMO) is indicated as a haemodynamic rescue strategy in decompensated acute or chronic heart failure presenting as cardiogenic shock. VA ECMO has a number of effects on the circulation including (i) perfusing end-organs, (ii) ventricular unloading, and (iii) improved coronary perfusion. It is a bridge to further therapies, to withdrawal of advanced therapies or to cardiac recovery. The VA ECMO platform in combination with a left ventricle (LV) vent allows for optimization of mechanical load of the LV, and thus for LV recovery. Over the last two decades, a large body of evidence has amassed to provide compelling evidence that mechanical load optimisation is critical to recovering the LV. The Impella device provides a percutaneous means of direct ventricular unloading with a remarkable safety profile. There is non-randomised data that suggests the addition of Impella CP in combination with VA ECMO improves survival and cardiac recovery in patients with cardiogenic shock. This research study will provide valuable data on changes at multiple levels with full and iteratively reduced mechanical circulatory support. It will provide the first randomised data to address this question directly.

You may be eligible for this study if you meet the following criteria:

• Conditions: Cardiogenic Shock
• Age: 99 years or below
• Gender: All