Venoarterial extracorporeal membrane oxygenation (VA-ECMO) in high-risk (HR) percutaneous coronary intervention (PCI)

Mechanical circulatory support is increasingly utilised in peri-procedural contexts. Herein we describe the characteristics and outcomes of patients undergoing high-risk (HR) percutaneous coronary intervention (PCI) with venoarterial extracorporeal membrane oxygenation (VA-ECMO) support.

Single centre, retrospective cohort study conducted at a quaternary Australian ECMO retrieval hospital.

Consecutive patients between January 2019 and June 2024, who received peripheral VA-ECMO support for HR-PCI were identified from the institutional ECMO database. The primary outcome was the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) to hospital discharge. Secondary endpoints included procedural success, incidence of vascular access and bleeding complications, acute kidney injury (AKI), and duration of mechanical circulatory support (MCS), ventilation, ICU and hospital length of stay.

Seventeen patients received VA-ECMO supported HR-PCI during the study period. The median age was 70 years (IQR; 59-78). Fourteen (82 %) patients were male; fifteen (88 %) had moderate to severe left ventricular dysfunction pre-procedurally. Ten (59 %) patients underwent emergency VA-ECMO support and seven (41 %) patients were supported prophylactically, with mean pre-procedural SYNTAX scores of 39 ± 12 and 30 ± 10, respectively. Seven MACCE events occurred, all being death in the emergency group. Fifteen patients (88 %) were successfully revascularised. Significantly more patients in the emergency versus the prophylactic group developed AKI (80 % vs 14 %, p = 0.02). There were significantly more vascular and access-related complications in the emergency group (7 vs 1, p = 0.049).

In seventeen patients undergoing HR-PCI, prophylactic VA-ECMO support was feasible, safe and associated with good short-term outcomes, whilst emergency VA-ECMO supported HR-PCI was associated with greater burden of mortality and morbidity. Larger prospective studies, including cost analysis comparing other MCS devices are required.