VENKAT B. MERUVA, DO: No financial relationships to disclose
Background: Extracorporeal membrane oxygenation (ECMO) provides critical cardiopulmonary support but traditionally limits invasive procedures due to anticoagulation requirements and patient instability. We report uncommon high-risk interventions successfully performed during ECMO support.
Methods: Retrospective review of four patients undergoing uncommon interventions on ECMO at a tertiary care center (August-November 2025), including serial bronchoscopies, cerebral aneurysm management, endoscopic gastric repair, and post-arrest cardiac interventions.
Outcome: Four patients (median age 59.5 years, range 33-76) received VV-ECMO or VA-ECMO . Interventions included: multiple bronchoscopies with biopsy revealing HSV pneumonitis; subarachnoid hemorrhage management with multiple aneurysms; endoscopic suturing of gastric perforation; and post-ECPR cardiac catheterization with stenting and mechanical support. Anticoagulation was individualized (continuation, reduction, or cessation).
Conclusion: Selected high-risk procedures can be performed during ECMO with individualized anticoagulation, multidisciplinary coordination, and aggressive complication management. Success requires careful patient selection, protocol-driven care, and institutional expertise. These cases expand understanding of procedural feasibility during ECMO support.
