Format

Send to

Choose Destination
Eur J Heart Fail. 2017 Mar;19(3):404-412. doi: 10.1002/ejhf.668. Epub 2016 Oct 6.

Concomitant implantation of Impella® on top of veno-arterial extracorporeal membrane oxygenation may improve survival of patients with cardiogenic shock.

Author information

1
Department of Cardiothoracic Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Vita Salute University, Milan, Italy.
2
Department of General and Interventional Cardiology, University Heart Centre Hamburg Eppendorf, Hamburg, Germany.
3
Department of Interventional Cardiology, IRCCS San Raffaele Scientific Institute, Vita Salute University, Milan, Italy.
4
Department of Intensive Care, Centre for Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg Eppendorf, Hamburg, Germany.
5
Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Vita Salute University, Milan, Italy.
6
Department of Cardiovascular Surgery, University Heart Centre Hamburg Eppendorf, Hamburg, Germany.
7
German Centre for Cardiovascular Research (DZHK), Partner site Hamburg/Lübeck/Kiel, Hamburg, Gemany.

Abstract

AIMS:

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support stabilizes patients with cardiogenic shock. Despite improved oxygenation and peripheral circulation, LV unloading may be impeded due to the increased afterload, resulting in a failing static left ventricle and in high mortality.

METHODS AND RESULTS:

We describe for the first time a large series of patients treated with the combination of VA-ECMO and Impella® compared with patients with VA-ECMO only. We retrospectively collected data on patients from two tertiary critical care referral centres. We enrolled 157 patients treated with VA-ECMO from January 2013 to April 2015: 123 received VA-ECMO support and 34 had concomitant treatment with VA-ECMO and Impella. A propensity-matching analysis was performed in a 2:1 ratio, resulting in 42 patients undergoing VA-ECMO alone (control group) compared with 21 patients treated with VA-ECMO and Impella. Patients in the VA-ECMO and Impella group had a significantly lower hospital mortality (47% vs. 80%, P < 0.001) and a higher rate of successful bridging to either recovery or further therapy (68% vs. 28%, P < 0.001) compared with VA-ECMO patients. A higher need for continuous veno-venous haemofiltration (48% vs. 19%, P = 0.02) and increased haemolysis (76% vs. 33%, P = 0.004) were reported in the study group due to higher survival. There was no difference in major bleeding rates between the two groups (VA-ECMO and Impella 38% vs. VA-ECMO 29%, P = 0.6).

CONCLUSIONS:

Concomitant treatment with VA-ECMO and Impella may improve outcome in patients with cardiogenic shock compared with VA-ECMO only. Nevertheless, randomized studies are needed to validate these promising results further.

KEYWORDS:

Extracorporeal circulation; Heart failure; Heart-assist device; Percutaneous left ventricular assist device; Shock

PMID:
27709750
DOI:
10.1002/ejhf.668
[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center