ECMO for high-risk procedures

Abstract

The impressive progresses of the last few decades have dramatically changed the management of cardiac conditions previously deemed “too high risk”. The use of extracorporeal membrane oxygenation (ECMO) as cardiopulmonary support has paved the way for new operative indications for those patients who were previously relegated to conservative medical management. The combination of a compact pump-oxygenator design, with smaller, percutaneous, flexible cannulae, makes the modern veno-arterial ECMO an ideal miniaturised cardiopulmonary bypass. In this chapter we will discuss the application of VA ECMO support during high-risk procedure such as percutaneous coronary interventions, transcatheter aortic valve implantation, post-infarct ventricular septal defect repair, and as bridge therapy before urgent pulmonary thromboembolectomy.