ECMO for High-Risk Procedures



Fig. 13.1
Percutaneous femoral cannulation with Preclose technique using PerClose Proglide vascular closure device (Abbott Vascular, Redwood City, CA, USA)



The main disadvantage of ECMO over full cardiopulmonary bypass is the lack of myocardial protection with cardioplegia and ventricular decompression. Moreover, in case of aortic regurgitation or bradyarrhythmia, peripheral retrograde flow can lead to ventricular overtension.

In case of heparin-induced thrombocytopenia, anticoagulation during ECMO can be safely achieved with the use of bivalirudin [47].

Finally, a point has to be made on safe cannulation; many patients experienced severe and catastrophic complications from iliac rupture or uncontrolled groin bleeding. In elective situation they are avoidable with careful preoperative workup (arterial CT angiogram to avoid calcified and tortuous vessels). Careful haemostasis is crucial especially when ECMO support follows thrombolysis post STEMI or PE [44, 45].



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Zeymer U, Vogt A, Zahn R, Weber MA, Tebbe U, Gottwik M, Bonzel T, Senges J, Neuhaus KL (2004) Predictors of in-hospital mortality in 1333 patients with acute myocardial infarction complicated by cardiogenic shock treated with primary percutaneous coronary intervention (PCI); Results of the primary PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK). Eur Heart J 25(4):322–328PubMedCrossRef

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Mar 27, 2017 | Posted by in CARDIOLOGY | Comments Off on ECMO for High-Risk Procedures

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