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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.

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



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.


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).


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.


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

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