Cardiogenic shock and cardiac arrest are life-threatening emergencies that result in high mortality rates. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) via peripheral cannulation is an option for patients who do not respond to conventional therapies. Left ventricular (LV) distention is a major limitation with peripheral VA-ECMO and is thought to contribute to poor recovery and the inability to wean off VA-ECMO. We report on a novel technique that combines peripheral VA-ECMO with off-pump insertion of a trans-apical LV venting cannula and a right ventricular decompression cannula.
CooperSJanghorbaniMCooperG. A decade of in-hospital resuscitation: outcomes and prediction of survival?Resuscitation2006; 68: 231–237.
2.
StretchRSauerCMYuhDDet al. National trends in the utilization of short-term mechanical circulatory support: incidence, outcomes, and cost analysis. J Am Coll Cardiol2014; 64: 1407–1415.
3.
NappLCKuhnCBauersachsJ. ECMO in cardiac arrest and cardiogenic shock. Herz2017; 42: 27–44.
4.
OgawaSRichardsonJESakaiTet al. High mortality associated with intracardiac and intrapulmonary thromboses after cardiopulmonary bypass. J Anesth2012; 26: 9–19.
5.
HlavacekAMAtzAMBradleySMet al. Left atrial decompression by percutaneous cannula placement while on extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg2005; 130: 595–596.
6.
FumagalliRBombinoMBorelliMet al. Percutaneous bridge to heart transplantation by venoarterial ECMO and transaortic left ventricular venting. Int J Artif Organs2004; 27: 410–413.
7.
PappalardoFSchulteCPieriMet al. Concomitant implantation of Impella® on top of veno-arterial extracorporeal membrane oxygenation may improve survival of patients with cardiogenic shock. Eur J Heart Fail2017; 19: 404–412.
8.
CohnWE. A transthoracic, left ventricular vent facilitates challenging sternal reentry. Ann Thorac Surg2010; 90: 679–680.
9.
ItoKYakuHShimadaYet al. Left ventricular apex venting during deep hypothermia in a case of difficult re-entry into the mediastinum. J Cardiovasc Surg2001; 42: 493–494.
