Emergency parallel mechanical circulatory support for ventricular fibrillation.

Extracorporeal and implantable mechanical circulatory support devices are increasingly used for refractory cardiogenic shock. We describe a patient with a continuous-flow left ventricular assist device (LVAD) who developed refractory ventricular fibrillation (VF) and deteriorating right ventricular function, requiring emergency implantation of venoarterial extracorporeal membrane oxygenation (ECMO), which supported the patient for 23 days of continuous VF until urgent transplantation. We illustrate challenges in managing parallel competing flows in the 2 circuits (Figure). Figure. Schematic illustration of parallel extracorporeal membrane oxygenation (ECMO) and left ventricular assist device (LVAD). The ECMO flow bypasses the lungs and LVAD. The LVAD flow consists of pulmonary venous return and aortic regurgitant flow (illustration AB Typofom). The patient is a 45-year-old man with dilated cardiomyopathy and a HeartMate II (Thoratec, Pleasanton, CA) as a bridge to …