Emergency VA-ECMO-assisted PCI in a 95-year-old: a nursing case report

Background Advanced age has historically been considered a relative contraindication to extracorporeal membrane oxygenation (ECMO) due to poor reported outcomes. However, contemporary guidelines advocate for comprehensive geriatric assessment over chronological age alone. Nevertheless, nursing literature on standardized care for ultra-elderly patients (≥90 years) requiring ECMO support remains scarce. Case presentation A 95-year-old woman presented with acute inferior ST-segment elevation myocardial infarction (STEMI) complicated by refractory cardiogenic shock (Killip class IV) and third-degree atrioventricular block. Given her extreme age, the family initially hesitated to consent to ECMO, prompting the placement of an intra-aortic balloon pump (IABP) as a bridge while emergency percutaneous coronary intervention (PCI) commenced. Following renewed consent, VA-ECMO was established via the right femoral artery and vein, running in parallel with the IABP to ensure hemodynamic stability during the procedure. The patient was successfully weaned from ECMO after 13 h of support and decannulated. The IABP and tracheal tube were successfully removed the following day. The nursing care was retrospectively reviewed and organized into four domains, informed by the Iowa Model of Evidence-Based Practice and Orem's Self-Care Deficit Theory. Outcomes On admission, the patient already had severe coagulopathy (PT 17.6 s, INR 1.44, PT activity 57.00%, TT >240.0 s, fibrinogen 1.87 g/L, APTT >180.0 s, D-dimer 4.38 mg/L, FDP 18.46 μg/mL), anemia (Hb 60 g/L), and hypoalbuminemia (23.9 g/L). During hospitalization, she developed right lower limb hypoperfusion (unmeasurable toe oxygen saturation, right groin ecchymosis) despite the use of a distal perfusion catheter, and a nosocomial worsening of a pre-existing pneumonia on day 4. VA-ECMO support lasted 13 h 15 min with concomitant IABP; she was successfully weaned and discharged on day 6 at the family's request. Discharge diagnoses included a puncture-site hematoma and suspected ischemic changes of the right toes. Conclusion This case documents real complications, including severe coagulopathy requiring transfusion, right lower limb hypoperfusion, right groin ecchymosis, and hospital-acquired pneumonia-together with a puncture-site hematoma and suspected toe gangrene recorded at discharge. These were managed without unplanned decannulation, major device-related infection, or pressure injury. It is presented as a hypothesis-generating, educational resource; causality cannot be inferred from a single case. The decision trajectory in this case—initial refusal of ECMO, IABP bridging, and family-initiated weaning—is itself instructive for ultra-elderly mechanical support. Multicenter prospective studies are warranted.