Percutaneous Axillary Venting During Venoarterial Extracorporeal Membrane Oxygenation: A Cost-Effective Bridge Strategy for Cardiac Arrest

Left ventricular (LV) distension is a life-threatening complication of venoarterial extracorporeal membrane oxygenation (VA-ECMO), requiring prompt venting in the setting of uncertain neurological prognosis. Current strategies, microaxial devices and surgical venting, are costly or invasive. A 55 year old male with cardiac arrest on VA-ECMO developed severe LV distension with refractory ventricular fibrillation. A 17 French Bio-Medicus cannula was inserted percutaneously via the right axillary artery and connected to the ECMO venous limb, achieving effective LV unloading in 8 minutes. Hemodynamic stability was maintained for 48 hours, enabling neurological assessment and successful organ donation. Percutaneous axillary venting is a cost-effective, rapidly deployable option for LV decompression during VA-ECMO, preserving therapeutic flexibility for cardiac recovery or organ donation.