11: Percutaneous Axillary Access for ECPR: Overcoming Challenging Femoral Access in Cardiogenic Shock - A Case Report.

Introduction: The aim of ECPR is to provide adequate perfusion, bridging to recovery, or destination therapy. The femoral vessels are typically preferred for cannulation due to their accessibility, especially in a percutaneous approach. However, in cases of advance critical lower limb issues the femoral approach can be inaccessible. In these instances, the axillary vessels can serve as an alternative for veno-arterial ECMO, although usually via a surgical approach. Case Report: A 66-year-old male with a history of hypertension, DM, advanced peripheral vascular disease with femoral stents, IHD, presented to the ER with chest pain and had a witnessed sudden cardiac arrest (shockable rhythm). After 15 minutes of CPR, an ECPR call was initiated. Due to challenging vascular access, a percutaneous axillary approach was attempted and achieved after the patient was placed on VA ECMO. VA-ECMO was initiated after 36 cycles. The right axillary artery was used for the return cannula (15 French) and the right femoral vein for the access cannula (26 French). A 5.5 French reperfusion cannula was placed in the axillary artery for distal limb perfusion. ECMO flow was maintained at 3.3-3.5 L/min. Results: Successful cannulation was achieved using the axillary artery approach, and adequate ECMO flow was maintained at 3.3-3.5 L/min. However, the patient ultimately did not survive due to multi-organ failure. Conclusions: The axillary artery cannulation presents a viable alternative in cases of challenging femoral vascular access, despite its complexities. This case underscores the importance of exploring and refining this approach for improved outcomes in similar critical situations.