Extracorporeal membrane oxygenation support as bridge to recovery in a patient with electrical storm related cardiogenic shock.

The use of venoarterial extracorporeal membrane oxygenation (ECMO) has been described in a few cases of neonates or infants as a bridge to recovery from intractable primary arrhythmias, but not yet in adults. We describe the case of a 50-year-old woman without a cardiac medical history, who developed incessant ventricular tachycardia refractory to medical therapy and leading to progressive severe cardiogenic shock. In this setting, the use of antiarrhythmic drugs with depressant cardiac contractility properties became highly risky and contraindicated. The institution of venoarterial ECMO ensured adequate vital organ perfusion and the weaning of catecholamine administration, thereby, ending the vicious cycle of catecholamine-driven electrical storm. Thanks to the cardiac assistance, the patient could be hemodynamically stabilized and received increasing doses of anti-arrhythmic therapy (verapamil) which stopped ventricular tachycardia. Within 3 days the patient could be weaned from ECMO. The patient fully recovered and did not present recurrence of arrhythmias at six months. The present case report supports the use of ECMO to support systemic circulation and to permit negative inotropic antiarrhythmic drug treatment for cardiogenic shock resulting from electrical storm.