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Therapeutic management of VA-ECMO support for cardiogenic shock: Two case reports

Hongfeng Yang, Jun Yan, Zhixin Yu, Yan Cai, Zhaochen Jin

Introduction: Cardiogenic shock is considered a serious stage of heart disease, and there is no better way to treat this. Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) is a well-established technology that can be used as potential life-saving measures in patients who present with cardiac arrest or severe hemodynamic instability by improving organ perfusion and oxygenation. However, it is usually complex and needs individualized decisions in a multidisciplinary approach to manage patients receiving extracorporeal membrane oxygenation, as defined clinical condition’s protocols are still lacking.

Case presentation: One patient was a 44-year-old man with out-of-hospital ventricular fibrillation was transferred to our hospital after initial cardiopulmonary resuscitation. In the emergency department, he presented with ST-segment elevation extensive anterior wall myocardial infarction and cardiogenic shock with paroxysmal ventricular tachycardia. After transfer to intensive care unit, VA-ECMO was implanted due to worsening cardiogenic shock and recovered slowly thereafter. Another patient was a 58-year-old woman presented refractory hypotension. As a bridge-therapy, VA-ECMO support was implanted and then the patient was taken to the cardiac catheterization laboratory where she experienced Percutaneous Coronary Intervention (PCI) and implanted a drug-eluting stent in the right coronary artery. Due to acute kidney injury, continuous renal replacement therapy was given to facilitate the control of fluid access balance, the removal of inflammatory media.

Conclusion: VA-ECMO is not only used as a temporary treatment strategy for cardiogenic shock, but also as a bridge-therapy. It is important to focus on improve the success rate of VA-ECMO treatment and avoid complications.