31: Preemptive Awake ECMO in High-Risk Patients for PCI: A Single Center Experience

Background: Patients with complex coronary artery disease and severely reduced left ventricular ejection fraction (LVEF) are often candidates for percutaneous coronary intervention (PCI), who are at higher risk of periprocedural complications and mortality. The use of prophylactic extracorporeal membrane oxygenation (ECMO) provides hemodynamic support and reduces the incidence of adverse complications; however, data on outcomes, particularly in awake patients, remain limited. Methods: A retrospective single-center analysis was conducted on patients who underwent elective high-risk PCI with prophylactic ECMO support while awake. The analysis focused on the in-hospital rate of major adverse cardiac and cerebrovascular events (MACCE), including procedural success, post-procedural complications, and in-hospital mortality. Results: In 2025, seven cases of high-risk PCI with ECMO support in awake, non-intubated patients were performed at the E.N. Meshalkin National Medical Research Center. The mean age was 65.1 (±9.5) years, and the majority were male (80%). The mean LVEF was 36% (±14.9). Mean SYNTAX II score was 41.8 (±6.7). Percutaneous vascular access for ECMO was established under local anesthesia with ropivacaine using a pre-close technique with suture-mediated closure devices. The mean duration of ECMO support was 82 (±38,4) minutes. Successful revascularization was achieved in 100% of patients. In all cases, VA-ECMO was weaned in the cath lab. No respiratory failure, MACCE and limb ischemia was observed during or after the PCI procedure. One case of bleeding from the cannulation site required blood transfusion. The mean ICU stay was 1 day, and the mean total hospital length of stay was 7,6 (±3,6) days. In-hospital survival was 100%. Limitations: A single centre experience. Conclusion: In our experience, elective high-risk PCI with awake VA-ECMO support is a feasible and safe strategy that facilitates revascularization and promotes early patient mobilization and recovery.