title: Emergency percutaneous implantation of veno-arterial extracorporeal membrane oxygenation in the catheterisation laboratory.
abstract: OBJECTIVE
  Our aim was to describe our protocol for emergency percutaneous implantation of femoral veno-arterial extracorporeal membrane oxygenation (VA ECMO) in the catheterisation laboratory and to compare its effectiveness and safety with implantation in the intensive care unit and the operating room.
  
  
  RESULTS
  Our retrospective observational study enrolled 56 consecutive patients undergoing VA ECMO implantation in the catheterisation laboratory (n=23), the intensive care unit (n=8) and the operating room (n=25). Among patients undergoing catheterisation laboratory implantation, 11 patients had profound cardiogenic shock but preserved arterial pulsations, and 12 patients had refractory cardiac arrest undergoing automated mechanical chest compression. Using our fluoroscopy-guided protocol, arterial and venous cannulas were successfully implanted and the desired ECMO flow obtained in each patient. There was no vessel perforation/dissection. Moderate/severe GUSTO or BARC 3 and 5 bleeding occurred in 13%. Ipsilateral limb ischaemia occurred in one of eight patients (13%) with upfront perfusion sheath implantation, and in two of three patients (75%) in whom this strategy was not used (p=0.15). There was no infection at the site of cannula implantation. Complications related to implantation in the catheterisation laboratory were comparable to surgical implantation in the operating room and percutaneous implantation in the intensive care unit using ultrasound guidance.
  
  
  CONCLUSIONS
  Fluoroscopy-guided emergency implantation of femoral VA ECMO by an interventional cardiologist in the catheterisation laboratory is effective and safe for both patients in cardiogenic shock and those in refractory cardiac arrest.
authors.affiliation: Center for Intensive Internal Medicine, University Medical Center Ljubljana, Ljubljana, Slovenia.
authors.forename: Tomaz
authors.initials: T
authors.lastname: Goslar
authors.forename: Rihard
authors.initials: R
authors.lastname: Knafelj
authors.forename: Peter
authors.initials: P
authors.lastname: Radsel
authors.forename: Misa
authors.initials: M
authors.lastname: Fister
authors.forename: Alenka
authors.initials: A
authors.lastname: Golicnik
authors.forename: Klemen
authors.initials: K
authors.lastname: Steblovnik
authors.forename: Vojka
authors.initials: V
authors.lastname: Gorjup
authors.forename: Marko
authors.initials: M
authors.lastname: Noc
mesh_terms: D000328:Adult; D000368:Aged; D001158:Arteries / Q000601:surgery*; D002404:Catheterization / Q000379:methods; D004630:Emergencies; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005260:Female; D006323:Heart Arrest / Q000601:surgery*; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000601:surgery*; D014680:Veins / Q000601:surgery*