ID:76 FC-D04-7 TAE for Hemorrhagic Complications After ECPR: A Retrospective Study and ECMO Circuit Simulation

Background: Hemorrhagic complications after ECPR may require urgent hemostasis; however, vascular access can be limited by extracorporeal life support devices and cannulation sites. Methods: We retrospectively analyzed 21 out-of-hospital cardiac arrest patients who underwent TAE after ECPR at our emergency and critical care center between April 2010 and December 2025. Outcomes included technical success, clinical success (absence of rebleeding within 24 hours), 30-day survival, bleeding sites, and vascular access routes. In addition, direct puncture of the ECMO circuit and contrast injection into the ECMO circuit were experimentally evaluated using a simulated ECMO circuit. Results: The most common cause of cardiac arrest was cardiac etiology (n = 17). The technical and clinical success rates of TAE were 100% and 85.7%, respectively, with a 30-day survival rate of 52.4%. Bleeding sites (overlapping cases) included hepatic injury (n = 4), retroperitoneal hemorrhage (n = 5), hemothorax (n = 2), mediastinal hemorrhage (n = 8), and other sites (n = 4). Access via the common femoral artery was restricted in 12 patients. Alternative access routes included the brachial artery (n = 4), radial artery (n = 3), direct puncture of the ECMO circuit (n = 3), and other routes (n = 2). In one patient, contrast injection into the ECMO circuit enabled identification and catheterization of the culprit vessel. In the simulated ECMO circuit, insertion of a 4-Fr sheath and catheter into arterial cannulas (14, 16, and 18 Fr) reduced flow by 23%, 14%, and 8%, respectively. To maintain baseline flow, post-oxygenator pressure increased by 69%, 38%, and 24%. No air entrainment or circuit damage occurred during contrast injection into the ECMO circuit. Conclusions: When conventional vascular access is challenging during TAE after ECPR, direct puncture of the ECMO circuit may be a feasible alternative. Contrast injection into the ECMO circuit may also aid in identifying the bleeding source in selected cases.