Coronary Artery Bypass Grafting Under ECPELLA Support After Out-of-Hospital Cardiac Arrest: A Case Report

The survival and social reintegration rate of out-of-hospital cardiac arrest (OHCA) remains extremely low. Venoarterial extracorporeal membrane oxygenation (VA ECMO) is used to support patients with cardiogenic shock. Combining Impella (Abiomed Inc., Danvers, MA, USA) with VA ECMO (ECPELLA) is a promising strategy to stabilize circulation and unload the left ventricle. We report a 46-year-old man who presented in cardiopulmonary arrest due to acute coronary syndrome. Coronary angiography showed multivessel disease, and echocardiography revealed an ejection fraction below 10%. ECPELLA was initiated immediately for hemodynamic stabilization and to promote myocardial recovery. After confirming neurological recovery, emergency coronary artery bypass grafting (CABG) using total arterial grafts and an aorta no-touch strategy was performed under ECPELLA support. The postoperative course was uneventful, and all grafts remained patent. Cardiac function improved, and the patient returned to society 3 months after surgery. ECPELLA enables circulatory stabilization and myocardial recovery in patients with severe cardiogenic shock after cardiac arrest. Combining ECPELLA with total arterial revascularization may achieve excellent neurological and social outcomes, even in cases previously considered unsalvageable.