A Staged Approach From Venoarterial Extracorporeal Membrane Oxygenation (V-A ECMO) to ProtekDuo Circuit for Right...

Choosing an appropriate mechanical circulatory support device in a timely fashion is essential during acute cardiogenic shock management. We present a case of a 52-year-old man who was admitted for elective left heart catheterization, whose procedure was complicated by right coronary artery dissection, leading to acute cardiogenic shock, and subsequently required microaxial left ventricular assist devices for both left and right mechanical circulatory support (left Impella CP and Impella RP). He went through a tumultuous course post circulatory support initiation and required various other configurations of support devices including venoveno-arterial pulmonary arterial extracorporeal membrane oxygenation (V-V-APa ECMO) and ProtekDuo. This is a single successful report of converting from venoarterial extracorporeal membrane oxygenation (V-A ECMO) to ProtekDuo in the setting of acute cardiogenic shock from right heart failure via a stepwise approach. The escalation and de-escalation of mechanical support in our patient illustrate the importance of choosing an appropriate configuration of mechanical support devices at the right time during the management of cardiogenic shock.