Orozco-Hernández, Erik J; Cozette Killian, A; Restrepo-Cárdenas, Juan; Wong, Ryan; Tallaj, José; Tyndal Jr, Charles M; McILwain, R Britt; Hoopes, Charles W

ABSTRACT

Temporary mechanical circulatory support (MCS) is used in the treatment of cardiogenic shock. options for temporary MCS typically include intra-aortic balloon pump placement (IABP), impella, left ventricular assist device (LVAD) placement, and veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Cannulation for VA-ECMO can be done either peripherally, or centrally. Central cannulation allows for antegrade arterial return and can be used when adequate flow cannot be achieved via peripheral cannulation, but it must be performed surgically. However, minimally-invasive techniques, such as transapical placement under the guidance of transesophageal echocardiography, have been described using the dual lumen cannula ProtekDuo^®. This approach may be associated with decreased hemolysis, improved mobility, and early extubation. This technique has been used as a bridge to LVAD, as well as bridge to recovery, IABPs and Impella^® both require access via either axillary or femoral artery. Our case describes the successful minimally invasive placement and use of a Spectrum^® cannula for central VA-ECMO in a patient who did not have adequate arterial access, as a bridge to LVAD, after which the patient achieved cardiac recovery.

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