title: [Case report of a patient on extracorporeal memebrane oyxgenation for cardiogenic shock not suitable for weaning in a peripheral center. Just a "problem" or is it feasible a treatment before patient transfer to a Hub center?].
abstract: 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 asscociated with high risk 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 succesfully 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.
authors.forename: Isidoro
authors.initials: I
authors.lastname: Di Bella
authors.forename: Alessandro
authors.initials: A
authors.lastname: Affronti
authors.forename: Uberto
authors.initials: U
authors.lastname: Da Col
authors.forename: Simone
authors.initials: S
authors.lastname: Perticoni
authors.forename: Paolo
authors.initials: P
authors.lastname: Procenesi
authors.forename: Temistocle
authors.initials: T
authors.lastname: Ragni
mesh_terms: D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D012770:Shock, Cardiogenic / Q000628:therapy*