Balloon Tamponade as a Bailout Strategy for Inferior Vena Cava Perforation Caused by Percutaneous ECMO Cannulation.

Inferior vena cava (IVC) perforation is a rare but potentially life-threatening complication of extracorporeal membrane oxygenation (ECMO) cannulation. An 81-year-old man undergoing percutaneous coronary intervention for acute coronary syndrome developed cardiopulmonary arrest requiring ECMO support. During cannulation via the left femoral vein, the venous cannula perforated the IVC, resulting in massive hemorrhage. Because of hemodynamic instability, cannula removal and stent-graft implantation were not feasible. Balloon tamponade using an 8.0 × 40-mm balloon via the right femoral vein successfully achieved hemostasis while the ECMO cannula remained in situ. Hemostasis was maintained until the following day, and no active bleeding was observed on contrast-enhanced computed tomography after balloon removal. This case demonstrates that balloon tamponade may serve as a simple bailout option for IVC perforation associated with ECMO cannulation.