Patient In Extracorporeal Membrane Oxygenation For Non-Weaning Cardiogenic Shock In A Peripheral Center. Only A "Problem" Or A Treatment Is Possible Before Transferring To A Hub Center?

Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is the treatment of choice for cardiogenic shock unresponsive to inotropes or intra-aortic balloon pumping. It provides a temporary mechanical circulatory support and blood oxygenation allowing time for cardiac recovery. If this is not the case, the patient may become suitable for heart transplantation or left ventricular assist device (LVAD) implantation and must be transferred to a referral center. In this setting, patient transport is associated with high risks and it is also difficult from a logistic point of view.We describe a relatively simple method to switch the assistance from VA ECMO to LVAD. Through a left minithoracotomy an apical cannula is inserted into the left ventricle and then connected to the venous return of ECMO. The progressive clamping of ECMO venous cannula transforms the circuit from VA ECMO to a LVAD. In fact, if the switching procedure is successfully accomplished, the left ventricle is drained, and thus unloaded, through the apical cannula while the blood to systemic circulation is provided from the femoral artery cannula. In this final setting, the oxygenator can be removed and the patient extubated, allowing an easier and less hazardous transfer to a heart transplantation center.