Cardiac intensive care management of high-risk percutaneous coronary intervention using the venoarterial ECMO support

Abstract

The emerging concept of high-risk percutaneous coronary intervention (HR-PCI) has required the adoption of a multidisciplinary team approach. Venoarterial ECMO (VA-ECMO) has been introduced as a temporary mechanical circulatory support (MCS) for HR-PCI patients in order to provide an adequate systemic perfusion during the procedure. Both patient's complexity and technological evolutions have catalyzed the development of critical care cardiology; however, ECMO therapy faces several challenges. Indeed, the management of patients on ECMO remains complex; moreover, the lack of specific recommendation for HR-PCI patients further complicates the management of these patients. In this narrative review, we give a reappraisal for the management of HR-PCI patients supported with VA-ECMO according to the available data published in current literature.

Prophylactic ECMO Support during Elective Coronary Percutaneous Interventions in High-Risk Patients: A Single-Center Experience

“…As a result, percutaneous coronary intervention (PCI) has become more complex and most frequently performed in patients with challenging coronary lesions [ 5 ].…”

“…As a result, percutaneous coronary intervention (PCI) has become more complex and most frequently performed in patients with challenging coronary lesions [5]. HR-PCI is performed usually in a population with one or more specifc characteristics related to either patients (increased age, CKD, COPD, HVD, HF, MI, PAD, and TIA or stroke), lesions (stenosis involving the LM, last patent conduits, presence of a severe multivessel coronary artery disease, CTOs, and heavily calcifed lesions), or the clinical presentation (hemodynamic status, left ventricular function, and presence or risk of electrical instability) [6,7].…”

Identification of key programmed cell death-related genes and immune infiltration in extracorporeal membrane oxygenation treatment for acute myocardial infarction based on bioinformatics analysis

“…Importantly, extracorporeal membrane oxygenation (ECMO) can significantly improve the cardiac output of patients and is gradually being used in high-risk acute coronary syndrome (ACS) with cardiogenic shock (9,10). ECMO can pump blood into the extracorporeal membrane lung device for adequate oxygenation and removal of carbon dioxide to ensure effective blood supply (11). Despite important advances in the application of ECMO in patients with AMI and cardiogenic shock, complications and mortality remain high.…”