# A Staged Approach From Venoarterial Extracorporeal Membrane Oxygenation (V-A ECMO) to ProtekDuo Circuit for Right Ventricular Support in Cardiogenic Shock: A Case Report

## TL;DR

A patient with acute cardiogenic shock due to right heart failure was successfully managed using a staged approach from V-A ECMO to ProtekDuo.

## Contribution

This is the first reported case of transitioning from V-A ECMO to ProtekDuo for right ventricular support in acute cardiogenic shock.

## Key findings

- A staged approach from V-A ECMO to ProtekDuo was successfully used for right ventricular support.
- The case highlights the importance of timely and appropriate mechanical support device selection in cardiogenic shock.
- Escalation and de-escalation of support devices were critical in managing the patient's condition.

## Abstract

Choosing an appropriate mechanical circulatory support device in a timely fashion is essential during acute cardiogenic shock management. We present a case of a 52-year-old man who was admitted for elective left heart catheterization, whose procedure was complicated by right coronary artery dissection, leading to acute cardiogenic shock, and subsequently required microaxial left ventricular assist devices for both left and right mechanical circulatory support (left Impella CP and Impella RP). He went through a tumultuous course post circulatory support initiation and required various other configurations of support devices including venoveno-arterial pulmonary arterial extracorporeal membrane oxygenation (V­V-APa ECMO) and ProtekDuo. This is a single successful report of converting from venoarterial extracorporeal membrane oxygenation (V-A ECMO) to ProtekDuo in the setting of acute cardiogenic shock from right heart failure via a stepwise approach. The escalation and de-escalation of mechanical support in our patient illustrate the importance of choosing an appropriate configuration of mechanical support devices at the right time during the management of cardiogenic shock.