Rescue venoarterial ECMO in cardiogenic shock complicated by refractory cardiac arrest during percutaneous coronary intervention

Cardiogenic shock represents the leading cause of death in hospitalized patients with acute coronary syndromes. Immediate revascularization, either percutaneous or surgical, currently represents the only intervention of proven benefit. Despite the lack of such proof, intraaortic balloon pump (IABP) and vasoactive drugs are typically used to improve hemodynamic stability on top of revascularization. Mechanical circulatory support devices beyond IABP such as Impella, TandemHeart and venoarterial extracorporeal membrane oxygenation (VA ECMO) are hemodynamically even more effective. Despite the lack of proven survival benefit, this technology might be lifesaving in case of profound hemodynamic deterioration in the catheterization laboratory. We describe a case of profound cardiac shock due to complicated coronary artery disease, recurrent cardiac arrest during PCI, intraarrest PCI intra-aortic balloon pump insertion and successful resuscitation after venoarterial ECMO placement. Complete revascularization was achieved following ECMO insertion and patient was discharged home on day 29 with no neurological sequelae with ejection fraction of 40%.