38: Awake veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for circulatory support as a bridge to ablation of ventricular tachycardia (VT) storm: A case report

Introduction: Veno-Arterial extracorporeal membrane oxygenation (VA-ECMO) is used to provide temporary mechanical circulatory support in patients with severe cardiac and respiratory failure. It can stabilize hemodynamics and perfusion in patients with acute ventricular tachycardia (VT) storm who are in cardiogenic shock or at risk of sudden hemodynamic collapse, especially when antiarrhythmic medications or other interventions fail. Catheter ablation is a definitive therapy aimed at eliminating the arrhythmic focus. VA-ECMO can stabilize them, acting as a bridge to ablation and providing time for recovery and preparation for a potentially more complex ablation procedure. Case Presentation: A 63-year-old male, known smoker, presented with an inferioposterior myocardial infarction (MI), underwent thrombolysis, and subsequently had a percutaneous coronary intervention (PCI). Two drug-eluting stents (DES) were placed in (LCX) and (OM 3). After 3 days, the patient was re-admitted with VT and required intubation. Electrical cardioversion (DC shocks) was administered, along with anti-arrhythmic medications. Coronary stents were confirmed patent upon coronary angiography, but slow flow was noted. An intra-aortic balloon pump (IABP) was inserted to support circulation on the second day the patient improved and he was extubated in the morning. In the evening, the patient experienced pulseless VT and cardiac arrest. After one cycle of cardiopulmonary (CPR), defibrillation was administered, and return of spontaneous circulation (ROSC) was achieved. Due to his critical condition, VA- ECMO was initiated under local anesthesia along with antiarrhythmic medications to manage the VT. Echocardiography showed significant left ventricular dysfunction. Due to recurrent arrhythmias, the patient was referred for VT ablation, which was successfully performed. An implantable cardioverter-defibrillator (ICD) was planned to prevent future arrhythmias before discharge. After 3 days, the patient’s condition improved, and ECMO was successfully removed. After 7 days, the IABP was removed as the patient remained stable. Conclusion: This patient’s course of care demonstrates the effective use of advanced mechanical support (ECMO and IABP) and procedural interventions (VT ablation) in stabilizing his condition and ensuring a positive outcome.