Extracorporeal membrane oxygenation for percutaneous coronary angioplasty in high risk patients

Improvements in percutaneous coronary angioplasty (PTCA) have broadened the scope of this therapy to higher risk patients. The authors used an extracorporeal membrane oxygenator (ECMO) system during seven PTCA procedures to provide rapid, safe, cardiopulmonary support for high-risk patients. Six patients underwent femoral cutdown and placement of arteriovenous cannulae before PTCA; one patient was cannulated percutaneously. In two patients, no ECMO support was used, whereas two of the remaining five patients were maintained on low flow (1.5 L/min) during the procedure and three patients were maintained with higher flows (average 3.0 L/min). All patients were removed from cardiopulmonary support with satisfactory hemodynamics and maintained on i.v. heparin for 12-48 hours. In six patients groin hematomas developed, in four deep venous thrombosis developed, and in one patient arterial occlusion after percutaneous cannulation developed. One patient died of retroperitoneal hemorrhage unrelated to the ECMO cannulation site. Six patients survived. This system can be rapidly deployed while providing satisfactory cardiopulmonary support.