Left Ventricular Physiological Effects of Veno-Arterial Extracorporeal Membrane Oxygenation Support During Cardiogenic Shock

Inclusion Criteria: * Age 18-75 years * SCAI D/E CS requiring VA-ECMO support based on treating team's judgement. * MAP \>65 mmHg on \<3 vasopressors/inotropes at the time of consent * Cardiogenic shock due to acute coronary syndrome identified by coronary angiography at the index hospitalization per standard cardiology practice Exclusion Criteria: * VA-ECMO for sepsis, pulmonary embolism, COVID-19 related cardiorespiratory failure, severe RV failure due to severe idiopathic pulmonary hypertension * CS due to other (non-ACS) etiologies * Known patient with severe left ventricular dysfunction and stage IV NYHA heart failure being evaluated for or with a history of LVAD and transplantation prior to commencement of VA-ECMO * Profound vasoplegia with MAP \<65 mmHg on 3 vasopressors/inotropes * Moderate to severe aortic regurgitation (contraindication to VA-ECMO) * Moderate to severe aortic stenosis (contraindication to LV instrumentation with PV loop catheter) * Bleeding complications requiring ongoing transfusions of blood products * Ischemic lower extremities * Evidence of circuit thrombosis or fibrin accumulation (turndown increases risk for stroke and clot formation) * Evidence of sepsis or septic shock * Evidence of LV thrombus on echocardiography (contraindication for accessing LV cavity with catheters)