Use of REBOA As an Adjunct to The Conventional Femoral Cut-Down For Bleeding Control During Veno-Arterial ECMO Decannulation

Introduction One of the potential complications of Extracorporeal Life Support is the arterial bleeding during decannulation. We present a case that describes the use of REBOA for hemorrhage control during femoral decannulation. Case Report 42-old-male who was suffering from ARDS and cardiogenic shock was admitted to the Intensive Care Unit and Veno-arterial (VA) ECMO was commenced. On day 4, his cardiac performance improved and we decided that there was no longer a need for cardiac support with ECMO. Thus, a conversion from VA to Veno-venous (VV) ECMO was planned. An additional venous cannula was placed and the arterial cannula in the femoral artery was withdrawn and the femoral artery wall was repaired just after a Zone III total REBOA was achieved from the contralateral femoral artery. There were not any significant changes in blood pressure, heart rate, and lactate levels before and after the procedure. Conclusion REBOA might be a useful tool in the hands of non-vascular surgeons to avoid unintended bleeding during the decannulation of a large-bore arterial cannulae.