It has been shown that extracorporeal membrane oxygenation (ECMO) may provide cardiopulmonary support during percutaneous coronary interventions (PCI) in patients with refractory cardiogenic shock. Current guidelines consider ECMO and implantable left ventricular assist devices in selected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients. High-risk PCI remains a viable revascularization strategy for those patients who are not suitable for surgery or those refusing it. However, such a subset of patients is considered to be at an extremely high risk of PCI complications as there is a risk of hemodynamic collapse during balloon inflations or complex procedures, particularly, if coronary dissection with vessel closure or no reflow occurs. This chapter is devoted to the use of ECMO support for high-risk complex PCI in NSTE-ACS patients without cardiogenic shock based on the theoretical rationale, observational retrospective single-center studies and clinical case examples.
Part of the book: Extracorporeal Membrane Oxygenation
Percutaneous coronary intervention (PCI) has evolved into the high-risk category in the past 2 decades. Endovascular patients are on average sicker than in the past due to increased age, complex anatomy, reduced global left ventricular systolic function and a greater frequency of surgical refusal. Extracorporeal membrane oxygenation (ECMO) can be taken into account for the management of extremely high-risk PCI without any hemodynamic instability. The rationale for the use of ECMO includes a lower risk of hemodynamic collapse which leads to low perfusion episodes minimization. In the evidence based on ECMO-assisted high-risk PCI, there are no randomized clinical trials but only observational studies and case reports. In this paper, we describe one-year long-term results of ECMO support for PCI in patients without hemodynamic disturbances.
Part of the book: Advances in Extra-corporeal Perfusion Therapies