Feasibility and safety of transcaval venoarterial extracorporeal membrane oxygenation in severe cardiogenic shock

Among patients with refractory cardiogenic shock (CS), venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides complete cardiocirculatory support; however, it is associated with high rates of vascular and bleeding complications and peripheral limb ischaemia1. Transcaval (TC) aortic access is a percutaneous technique to deliver large-bore catheter devices from a femoral vein into the abdominal aorta in patients with inadequate peripheral arterial access2. In the setting of CS, TC access may enable VA-ECMO in patients with diseased iliofemoral arteries that are unsuitable for accommodating arterial cannulas. To date, the use of TC access for VA-ECMO is limited to only single case reports and has not been previously investigated3. Here we report the in-hospital outcomes of the largest case series to date of TC-VA-ECMO.

A total of 22 consecutive patients who were in refractory CS but whose peripheral arterial access was unsuitable underwent VA-ECMO cannulation via TC access between 2018 and 2023 at a large tertiary shock centre. Our technique for TC-VA-ECMO without the use of preplanning contrast computed tomography (CT) has been previously described3. Left ventricular (LV) unloading, when...