Extracorporeal life support (ECLS) is a very effective bridging
therapy in patients with refractory
ventricular tachycardia (VT) associated with
cardiogenic shock. A moribund patient in extremis, is not amenable to optimization by standard ACC/AHA guidelines. New approaches and novel salvage techniques are necessary to improve outcomes in patients with refractory clinical settings such as malignant ventricular
arrhythmias, cardiac arrest,
cardiogenic shock and/or pulmonary failure until further management options are explored. Data base searches were done using key words such as ECLS, VT,
cardiac arrest, VT ablation, venoarterial extra-corporeal membrane oxygenation (VA-ECMO). The use of ECLS has been described in a few case reports to facilitate VT ablation for incessant VT refractory to medical
therapy. For patients with, out-of- hospital
ventricular fibrillation (VF) and VT, Minnesota
Resuscitation Consortium has implemented emergent advanced perfusion and reperfusion strategy, followed by coronary angiography and primary coronary intervention to improve outcome. The major indications for ECLS are
cardiogenic shock related to acute
myocardial infarction,
myocarditis, post embolic acute
cor pulmonale, drug intoxication and
post cardiac arrest syndrome with the threat of multi-organ failure. ECLS permits the use of negative inotropic
antiarrhythmic drug therapy, facilitates the weaning of
catecholamine administration, thereby ending the vicious cycle of
catecholamine driven electric storm. ECLS provides hemodynamic support during ablation procedure, while mapping and induction of VT is undertaken. ECLS provides early access to cardiac catheterization laboratory in patients with
cardiac arrest due to shockable rhythm. The current evidence from literature, supports the use of ECLS to ensure adequate vital organ perfusion in patients with refractory VT. ECLS is a safe, feasible and effective therapeutic option when conventional
therapies are insufficient to support cardiopulmonary function. A highly driven multidisciplinary team approach is essential to accomplish this task.