Frontiers in Cardiovascular Medicine (Feb 2023)

ECMELLA as a bridge to heart transplantation in refractory ventricular fibrillation: A case report

  • Raphaël Giraud,
  • Raphaël Giraud,
  • Raphaël Giraud,
  • Benjamin Assouline,
  • Benjamin Assouline,
  • Benjamin Assouline,
  • Haran Burri,
  • Haran Burri,
  • Dipen Shah,
  • Dipen Shah,
  • Philippe Meyer,
  • Philippe Meyer,
  • Sophie Degrauwe,
  • Sophie Degrauwe,
  • Matthias Kirsch,
  • Karim Bendjelid,
  • Karim Bendjelid,
  • Karim Bendjelid

DOI
https://doi.org/10.3389/fcvm.2023.1074544
Journal volume & issue
Vol. 10

Abstract

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BackgroundExtracorporeal membrane oxygenation (ECMO) is an effective cardiorespiratory support technique in refractory cardiac arrest (CA). In patients under veno-arterial ECMO, the use of an Impella device, a microaxial pump inserted percutaneously, is a valuable strategy through a left ventricular unloading approach. ECMELLA, a combination of ECMO with Impella, seems to be a promising method to support end-organ perfusion while unloading the left ventricle.Case summaryThe present case report describes the clinical course of a patient with ischemic and dilated cardiomyopathy who presented with refractory ventricular fibrillation (VF) leading to CA in the late postmyocardial infarction (MI) period, and who was successfully treated with ECMO and IMPELLA as a bridge to heart transplantation.DiscussionIn the case of CA on VF refractory to conventional resuscitation maneuvers, early extracorporeal cardiopulmonary resuscitation (ECPR) associated with an Impella seems to be the best strategy. It provides organ perfusion, left ventricular unloading, and ability for neurological evaluation and VF catheter ablation before allowing heart transplantation. It is the treatment of choice in cases of end-stage ischaemic cardiomyopathy and recurrent malignant arrhythmias.

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