ECMO supported PROTECTED CHIP PCI in Post CABG ACS AMICS and in hospital Cardiac arrest
Presenter
Sivaramakrishnan Manoj, MBBS, MD, DNB, DM, DNB, FACC, FESC, FSCAI, KAUVERY HOSPITAL, CHENNAI, India
Sivaramakrishnan Manoj, MBBS, MD, DNB, DM, DNB, FACC, FESC, FSCAI, KAUVERY HOSPITAL, CHENNAI, India
Title
ECMO supported PROTECTED CHIP PCI in POST CABG ACS AMICS with recurrent in hospital Cardiac Arrest
Introduction
60year lady with Class III Effort angina 7months post CABG with LVEF ~25% on presenting to Coronary Care Unit and fast progressing acute HFrEF suffering recurrent VT and cardiac arrest on multiple inotropes
Clinical Case
The above lady was on maximal medical therapy for acute heart failure and ACS NSTEMI as well. She was on invasive ventilator, receiving multiple DC shocks for fast monomorphic VT and multiple inotropes, developed Acute Kidney Injury and taken up for Coronary angiography that showed single critically diseased venous graft to Diagonal and a critical native proximal LAD critical stenosis.
Discussion
The vital support for hemodynamic stability and successful CHIP PCI to LM to LAD into major diagonal vessel was possible from VA ECMO at time Impella was no available in India. The hemodynamic uncoupling and Electro-mechanical dissociation during balloon inflation periods resulting in non pulsatile circulation support is illustrated with cardiac recovery of the patient from ACS AMICS and acute heart failure is discussed