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• Provide systemic perfusion
• Decompress LV: LV wall stress reduced by 80%
• 40% decrease in myocardial demand
• Flow dependent on intravascular volume and RV function

• Cardiac index <1.8L/min/m²
• Systolic BP <80mmHg
• PAWP / LAP >20mmHg

• Drainage: LA / LV
• Return of blood: aorta
• LA catheter inserted for accurate monitoring of left-sided filling pressures

• Flow intitiated to achieve systemic flow of 2.2L/min/m²
• LA pressure 10-15mmHg
• Adequacy of perfusion is assessed by mixed venous oxygen saturations
• Stop inotropes (decrease myocardial demand)
• Vasopressors may be needed to maintain MAP >75mmHg
• Heparinise to achieve ACT 175-200seconds

Inadequate flow due to:

• Improper position of draining cather
• RV failure

• Provide pulmonary blood flow 
• Decompress RV (RV infarction, pulmonary hypertension etc)

On maximal medical support with

• RAP >20mmHg
• LAP <15mmHg
• No TR

• Drainage RA
• return of blood: Pulmonary artery

• Flow initiated to achieve rate of 2.2L/min/m2
• LA pressure to 15mmHg
• Maintain high RA pressure 5-10mmHg
• Heparinise (as above)

Inadeqaute flow due to:

• Improper position of catheter
• Cardiac tamponade (compression of RA)