Extracorporeal membrane oxygenation for challenging percutaneous intervention

Extracorporeal membrane oxygenation (ECMO) provides innumerous benefits in the preoperative and postoperative/critical care phases of patient care. Typically, ECMO is used in emergency situations after standard medical practices have failed, or a life-threatening complication during the periprocedural time of a percutaneous intervention. This inherent morbidity and mortality with utilization of ECMO is from vascular and neurologic complications. However, recent evidence suggests the use of prophylactic ECMO can reduce morbidity and mortality associated with high-risk patients undergoing challenging percutaneous cardiac interventions. Prophylactic ECMO has been utilized for several years in challenging percutaneous coronary interventions (PCIs) with tremendous success. In addition to PCI, prophylactic ECMO has been utilized in both transcatheter aortic valve implantation, ventricular ablations, and percutaneous mitral valve repair. While ECMO will continue to remain a bailout strategy for disastrous intraoperative complications, careful preoperative planning and patient selection allow prophylactic ECMO to be utilized with tremendous percutaneous operative success.