Cardiogenic shock is the main cause of death in hospitalized patients with acute coronary syndromes, with a high mortality rate. The management of graft thrombosis after coronary artery bypass graft (CABG) surgery is challenging and the best revascularization strategy is not well defined. In patients who develop cardiac arrest due to graft thrombosis, the benefits of mechanical support during advanced cardiac life support are uncertain. Rescue extracorporeal cardiac bypass resuscitation has been used in the context of cardiopulmonary arrest, with survival rates of around 34.7% of which 28.5% with good neurological outcome.
We present here the case of a patient who developed cardiogenic shock after CABG graft occlusion. The patient suffered refractory cardiac arrest during percutaneous revascularization and received rescue cardiopulmonary support. Revascularization was achieved and there was a successful resuscitation with the placement of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) and an Impella CP device. After a 29-day hospitalization the patient was discharged with no neurological sequelae.
Although there is limited evidence of the benefit of a combined use of mechanical support (VA-ECMO with other mechanical devices) in the management of cardiogenic shock and cardiac arrest following CABG surgery, there seems to be a lower mortality with this approach, and possibly more favourable neurological outcomes. Further research is needed to elucidate the advantages of Impella vs. intra-aortic balloon pump combined with VA-ECMO in such patients.