Pictorial representation of the four hemodynamic possibilities in patients supported by VA-ECMO with PAC and ALPP monitoring. Patients with adequate ALPP and low PAC-derived filling pressures do not require further unloading maneuvers. In the case of low ALPP and low PAC filling pressures, correction of hypovolemia and/or SVR will likely restore ALPP. Patients with adequate ALPP and elevated PAC filling pressures may likely require volume removal. In the case of low ALPP and elevated PAC filling pressures, the patient likely requires at a minimum non-invasive and failing that, invasive methods of LV unloading. ALPP: Arterial Line Pulse Pressure; LV: Left Ventricle; PAC: Pulmonary Artery Catheter; SVR: Systemic Vascular Resistance; VA-ECMO: Venoarterial Extracorporeal Membrane Oxygenation.