A case series: alternative access for refractory shock during cardiac arrest

Area of Science:

• Interventional Cardiology
• Critical Care Medicine
• Vascular Access Techniques

Background:

• Severe aortic stenosis necessitates transcatheter aortic valve replacement, with transcaval and axillary artery access as safe alternatives.
• Mechanical circulatory support devices like Impella CP® and extracorporeal cardiopulmonary resuscitation (ECMO) are vital in cardiac arrest scenarios.
• Arterial access is critical for deploying these life-saving devices during emergent situations.

Observation:

• Three patients experiencing cardiac arrest underwent emergent placement of Impella CP® or ECMO via transcaval or axillary artery access.
• Case 1: A 59-year-old woman received a transcaval Impella CP® after ventricular fibrillation arrest.
• Case 2: A 67-year-old man with coronary vasospasm had an axillary artery Impella CP® placed during cardiac arrest.
• Case 3: A 67-year-old man required axillary artery ECMO cannulation following an unsuccessful chronic total occlusion repair.

Findings:

• All three patients achieved return of spontaneous circulation after the emergent placement of mechanical circulatory support devices.
• This case series demonstrates the successful application of transcaval and axillary artery access in refractory cardiac arrest.
• No prior case reports detail the use of these specific access routes for Impella CP® during cardiac arrest.

Implications:

• Rapid cardiopulmonary support via alternative access routes can improve survival chances for younger patients experiencing cardiac arrest.
• Interventional operators should master advanced large-bore alternative access techniques for emergent mechanical circulatory support.
• These techniques offer critical, potentially life-saving, options when standard access is not feasible in cardiac arrest.