Practical concepts of catheter-directed aspiration thrombectomy in ECMO-supported patients

Abstract

To the Editor, The use of extracorporeal membrane oxygenation (ECMO) circulatory support devices in patients with cardiac arrest, shock, or refractory respiratory failure due to pulmonary thromboembolism is increasingly recognized as a safe and effective therapy.1-3 With the aim of improving the hemodynamic and respiratory status of these patients, the adjuvant use of transcatheter pulmonary thrombectomy through thrombus aspiration is increasingly common.4-6 However, combining these two therapies requires careful consideration of technical issues to ensure procedural success and prevent additional risks. ECMO consists of a centrifugal pump that rotates at high speed to create negative pressure in the central axis, allowing blood to be aspirated through the venous insertion cannula (figure 1 of the supplementary data). Subsequently, after passing through the ECMO, the blood is pumped through a second cannula—arterial or venous—to be reintroduced into the patient’s circulatory system. Figure 1. A: valve of a large-bore thrombus aspiration catheter. The asterisk shows the 2 buttons that, when pressed, allow the valve to open. B: opening of the valve by pressing the 2 buttons. Support needs to be reduced or stopped before opening this or any other valve in patients on extracorporeal membrane oxygenation (ECMO). Sealing refers to the quality of a system...