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

• Published in: Heart failure reviews Vol. 25; no. 5; pp. 833 - 846
• Main Authors: Zuin, Marco, Rigatelli, Gianluca, Daggubati, Ramesh
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.09.2020; Springer Nature B.V
• Subjects: Acute Coronary Syndrome - therapy; Angioplasty; Cardiology; Critical Care - methods; Extracorporeal Membrane Oxygenation - methods; Humans; Management; Medicine; Medicine & Public Health; Percutaneous Coronary Intervention - methods; Perfusion; Stents; Shock; Mechanical circulatory support; Hemodynamic monitoring; Critical care; High-risk PCI; Intensive care unit; VA-ECMO
• ISSN: 1382-4147; 1573-7322
• DOI: 10.1007/s10741-019-09862-6

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.