Successful Extracorporeal Cardiopulmonary Resuscitation Despite Aortic Occlusion

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Critical Care Medicine

Background:

• Severe coronary artery disease can lead to refractory ventricular fibrillation cardiac arrest.
• Total occlusion of the infrarenal aorta presents a challenge for circulatory support.
• Existing surgical bypass grafts may offer alternative cannulation routes.

Purpose of the Study:

• To describe the successful initiation of extracorporeal cardiopulmonary resuscitation (ECPR) in a patient with severe coronary artery disease and total infrarenal aortic occlusion.
• To demonstrate the feasibility of using a pre-existing surgical vascular graft for ECPR cannulation.
• To highlight that aortic occlusion with bypass is not an absolute contraindication for extracorporeal membrane oxygenation (ECMO).

Main Methods:

• ECPR was initiated in a patient with refractory ventricular fibrillation cardiac arrest.
• Cannulation for ECPR was performed via a bifemoral-axillary surgical graft, utilizing the axillary artery for central circulation and the femoral-femoral graft for left leg perfusion.
• The patient subsequently underwent coronary artery bypass graft surgery while on ECMO support.

Main Results:

• Successful initiation and maintenance of ECPR via the surgical graft.
• The patient was extubated neurologically intact and weaned from ECMO.
• The patient was discharged home neurologically intact and independent.

Conclusions:

• Cannulation for ECPR via a surgical vascular graft is feasible.
• Total infrarenal aortic occlusion with a surgical bypass is not an absolute contraindication for ECMO.
• ECPR via a surgical graft can be a life-saving option for select cardiac arrest patients.