Case report: venoarterial extracorporeal membrane oxygenation supported severe coronary vasospasm with recurrent cardiac arrest

This case reflects a wide range of treatment possibilities for recurrent coronary vasospasm although optimal medical treatment, including circulatory support with VA-ECMO during the hyperacute phase, which provided significant benefit in the context of recurrent witnessed cardiac arrest due to pulseless electrical activity. Long-acting vasodilators (molsidomine, nicorandil), alongside less commonly used treatments (magnesium, fluvastatin), may be useful in patients with refractory vasospasm. Lastly, it seems reasonable to consider transient stellate ganglion ablation and thoracic sympathectomy as the final step of treatment if severe episodes persist. Nevertheless, stronger evidence is needed for the aforementioned strategies.