Poster 023: First Time Cardiac Arrest Managed with ECMELLA: Early Post-Arrest Support and Recovery

Background: Cardiac arrest in the setting of acute coronary syndrome remains a major cause of morbidity and mortality. Early initiation of mechanical circulatory support strategies such as ECMELLA (combination of veno-arterial extracorporeal membrane oxygenation [ECMO] and Impella) can provide hemodynamic stabilization, facilitate revascularization, and improve post-arrest recovery.

Methods: A 70-year-old male with hypertension and tobacco use presented with chest pain and shortness of breath. He was diagnosed with non–ST-elevation myocardial infarction (NSTEMI) and underwent cardiac catheterization, which revealed multivessel cardiac disease. Cardiothoracic surgery deemed him a poor candidate for coronary artery bypass grafting.
During hospitalization, the patient suffered a pulseless electrical activity arrest requiring 45 minutes of CPR. He was placed on veno-arterial ECMO and taken urgently to the catheterization laboratory, where a stent was placed in the left anterior descending artery and an Impella device was inserted. He was monitored in the intensive cardiac care unit.
During his course, he developed ventricular tachycardia requiring defibrillation, underwent transcatheter aortic valve replacement (TAVR), and subsequently had Impella removal. He was successfully extubated and demonstrated neurological recovery.

Outcome: Despite stabilization, the patient experienced recurrent ventricular fibrillation and monomorphic ventricular tachycardia beyond 48 hours of revascularization. With ischemic cardiomyopathy and left ventricular ejection fraction of 25%, he met guideline-directed indications for implantable cardioverter-defibrillator (ICD) placement for secondary prevention of sudden cardiac death. He is currently awaiting ICD placement by electrophysiology cardiology.
Post-procedure plans included initiation of apixaban with discontinuation of heparin infusion, and continuation of clopidogrel with apixaban while discontinuing aspirin to avoid triple therapy. Maintenance diuresis continued with oral bumatenide.

Conclusion: This case highlights ECMELLA as a lifesaving bridge in prolonged cardiac arrest, enabling revascularization, valve intervention, and neurologic recovery. It underscores the importance of guideline-directed ICD placement and careful antithrombotic management, demonstrating how early mechanical circulatory support stabilizes critically ill patients and improves post-arrest outcomes.