Retrospective Analysis of Procedural Sedation During Extracorporeal Membrane Oxygenation–Supported High-Risk Percutaneous Coronary Intervention

Introduction. High-risk percutaneous coronary intervention (HR-PCI) increasingly requires mechanical circulatory support to maintain hemodynamic stability in patients with advanced coronary artery disease and severe ventricular dysfunction. Evidence from transcatheter aortic valve implantation and emerging reports of ECMO-assisted PCI suggest that conscious sedation may reduce respiratory complications and resource utilization compared with general anesthesia; however, data specific to ECMO-supported HR-PCI are scarce. Materials and Methods. We conducted a single-center retrospective observational study including consecutive adult patients undergoing scheduled ECMO-supported HR-PCI under a procedural (conscious) sedation strategy between January 2019 and January 2026. Procedural sedation aimed to preserve spontaneous breathing (target Richmond Agitation–Sedation Scale 0 to -2). The primary endpoint was procedural success without major respiratory complications. Results. A total of 27 patients underwent scheduled ECMO-supported high-risk PCI under procedural (conscious) sedation. The primary endpoint was achieved in 23 patients (85.2 %). No cases of intraprocedural airway compromise or unplanned conversion to general anesthesia were observed. Post-procedural endotracheal intubation occurred in three patients (11.1 %) and was required only after completion of PCI. In-hospital mortality was 11.1 %, and successful weaning from ECMO at the end of the procedure was achieved in 74.1 % of cases. Respiratory complications were infrequent, and intensive care unit utilization was limited. Conclusions. In this single-center experience, procedural (conscious) sedation during scheduled ECMO-supported HR-PCI was feasible and associated with acceptable clinical outcomes, low rates of respiratory complications, and limited resource utilization. These findings extend prior evidence from structural heart interventions and recent ECMO-assisted PCI reports, supporting conscious sedation as a viable alternative to routine general anesthesia in carefully selected patients undergoing elective ECMO-supported HR-PCI at experienced centers.