Dynamic Extracorporeal Life Support in a Patient With Left Ventricular Assist Device and Electrical Storm: A Case Report

Left ventricular assist device (LVAD)-supported patients experiencing electrical storm (ES) and cardiac arrest present unique management challenges. Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) is commonly used for extracorporeal cardiopulmonary resuscitation (ECPR), but its application in LVAD-supported patients presents hemodynamic complexities. Alternative ECMO modes, including venopulmonary (VP) and hybrid venoarteriopulmonary (VAP) ECMO, may provide tailored circulatory and respiratory support in select cases. This case report describes a patient with a newly implanted LVAD who developed ES, refractory right ventricular failure, and cardiac arrest. The patient underwent staged ECMO support, transitioning from VA ECMO for ECPR to hybrid VAP ECMO and ultimately to VP ECMO, based on evolving hemodynamic needs.