Axillary VA-ECMO Implantation Under Regional Block Anesthesia.

BACKGROUND

Axillary venoarterial extracorporeal membrane oxygenation (VA-ECMO) implantation for refractory cardiogenic shock traditionally requires general anesthesia, risking hemodynamic compromise in critically ill patients.

FIRST-IN-HUMAN/EARLY REPORTS SUMMARY: We report the first-in-human axillary VA-ECMO cannulation via Dacron tube graft performed under locoregional anesthesia with sedation in a 58-year-old man with SCAI stage D cardiogenic shock. The procedure was successfully completed, with excellent patient tolerance, hemodynamic stability, and preserved neurologic monitoring throughout. The patient achieved successful ECMO weaning after 7 days, with preserved limb function and no cannulation-related complications through 30-day follow-up.

DISCUSSION: This novel approach avoided general anesthesia-related hemodynamic compromise while enabling continuous neurologic assessment. Subsequent patient mortality at 75 days resulted from unrelated device infections and was not attributable to the innovative cannulation technique.

NOVELTY: This is the first reported axillary ECMO cannulation under regional anesthesia, eliminating general anesthesia risks in critically ill cardiac patients.

TAKE-HOME MESSAGE: Regional anesthesia enables safe axillary ECMO cannulation in high-risk patients while preserving hemodynamic stability and neurologic monitoring capabilities.