Targeted Nitroglycerin Infusion during VA-ECMO to Reduce LV Afterload and Prevent Pulmonary Edema: A Two-case Experience

AMI with severe LV dysfunction, supported on VA-ECMO for 100 hours.IABP improved LV venting; NTG further enhanced AV opening, reduced LV distension, and enabled successful ECMO weaning.Patient discharged. Case 2AMI with low EF requiring PCI to the left main artery.IABP was inserted at initiation, improving LV unloading.NTG infusion improved pulsatility, reduced pulmonary edema, and supported successful ECMO liberation after 7 days.Both patients were discharged.No NTG-related major hypotension occurred. LimitationsSmall sample size and observational format. ConclusionsCombined IABP and controlled NTG infusion during VA-ECMO were feasible and effective in improving LV unloading and hemodynamic stability.This strategy may be valuable where advanced unloading devices are limited, provided monitoring is meticulous.