Elective institution of ECLS for primary PCI is associated with improved outcomes. A single center experience

Background/Purpose: The use of extracorporeal life sup- port (ECLS) in the cath lab has increased in recent years, as it provides adequate support during high‐risk angioplasty pro- cedures (HR‐PCI). Timing of ECLS initiation is crucial and we aim to elucidate the diffecences in early outcome between elective or rescue (ECPR) use of VA‐ECMO during HR‐PCI. Methods: We retrospectively reviewed the use of venous‐ar- terial ECMO (VA‐ECMO) as a support during HR‐PCI for acute coronary syndrome (ACS) with cariogenic shock (CS). Only the patients who met the criteria of the ELSO guide- lines were selected for receiving VA‐ECMO. The results of the group in which the VA‐ECMO was started electively be- fore or after the procedure were analyzed and compared with the group of patients in which it was started under cardiac massage after hemodynamic deterioration (ECPR) during the procedure. Results: From July 2013 to May 2017, 14 patients aged 60.1 ± 9.26 year received VA‐ECMO for ACS, with the clin- ical diagnosis of (CS). In seven patients the VA‐ECMO was initiated pre‐PCI or post‐PCI (sliding fast on inotropic sup- port), while in the other seven patients the VA‐ECMO was used as ECPR after hemodynamic collapse during the pro- cedure. The ECMO setup was percutaneously in all patients through the femoral vessels. All patients received culprit le- sion revascularization. Intra‐aortic balloon pump (IABP) was used in 11 patients (78.5%), preoperatively in 100% of theECPR group. We were able to wean four patients in the “elec- tive” group, while only three in the ECPR group; one patient was discharged on support and transplanted. The “elective group” had a lower mortality (2 [28.6%] vs 4 [57.1%]; “elec- tive” vs “ECPR” group). Conclusions: Elective use of VA‐ECMO for high‐risk PCI is associated, even in this small series, with improved in‐hospi- tal survival. Our results foster the pre‐PCI use of VA‐ECMO in HR‐PCI patients presenting with CS.