- Video A: venous and arterial guidewires are visualised—please also note the tip of the previously inserted IABP
- Video B: venous drainage cannula in inferior vena cava is visualised.
A 39-year-old man (BMI 22 kg/m²) with no prior medical history was admitted to a spoke centre with late-presenting anterior ST-segment elevation myocardial infarction (STEMI). He reported chest pain occurring two days earlier and is experiencing dyspnoea. Echocardiography identified a severe biventricular systolic dysfunction with non-restrictive ventricular septal defect (VSD).
Coronary angiography demonstrated single-vessel coronary artery disease with multiple stenoses involving the left anterior descending artery (LAD). Percutaneous coronary intervention (PCI) was performed with deployment of two drug-eluting stents, achieving TIMI 2 flow, and an intra-aortic balloon pump was inserted for haemodynamic support.
Due to progressive deterioration (lactates peaked at 10.4 mmol/L), he was referred to our hub centre for further management. On arrival, patient was intubated due to respiratory distress secondary to pulmonary oedema, intravenous continuous infusions of furosemide and adrenaline at inotropic dose were started. Peripheral venoarterial ECMO was inserted to restore perfusion.
Admitted to cath lab for peripheral venoarterial ECMO insertion:
A. Visualisation of venous (left) and arterial (right) guidewires for ECMO insertion. Tip of intraortic balloon pump is visualised
B. Drainage cannula in inferior vena cava
| Arterial Blood Gas | Laboratory Tests |
|---|---|
| pH: 7.29 | Total bilirubin: 2.1 mg/dL |
| PaO₂: 9.2 kPa (69 mmHg) | AST: 92 U/L |
| PaCO₂: 4.8 kPa (36 mmHg) | ALT: 85 U/L |
| HCO₃⁻: 17 mmol/L | Creatinine: 1.8 mg/dL (159 µmol/L) |
| Base excess: −8 mmol/L | Blood urea nitrogen (BUN): 38 mg/dL (6.3 mmol/L) |
| Lactate: 5.6 mmol/L | White blood cells: 12.4 ×10⁹/L |
| SaO₂: 93 % | Platelets: 210 ×10⁹/L |
| Hemoglobin: 7.8 g/dL |
- Cubeddu RJ, Lorusso R, Ronco D, Matteucci M, Axline MS, Moreno PR. Ventricular Septal Rupture After Myocardial Infarction: JACC Focus Seminar 3/5. J Am Coll Cardiol. 2024;83:1886-1901.
- McDonagh TA, Metra M, Adamo M, et al; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42:3599-3726.
- Roncon-Albuquerque R Jr, Gaião S, Vasques-Nóvoa F, et al. Standardized approach for extubation during extracorporeal membrane oxygenation in severe acute respiratory distress syndrome: a prospective observational study. Ann Intensive Care. 2023;13:86.
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