Federico Pappalardo1, Christian Schulte2, Marina Pieri1, Benedikt Schrage2, Rachele Contri3, Gerold Soeffker4, Teresa Greco1, Rosalba Lembo1, Kai Müllerleile2, Antonio Colombo3, Karsten Sydow2, Michele De Bonis5, Florian Wagner6, Hermann Reichenspurner6, Stefan Blankenberg2,7, Alberto Zangrillo1, Dirk Westermann2,7. 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.
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.
Authors: Manal Alasnag; Alexander G Truesdell; Holli Williams; Sara C Martinez; Syeda Kashfi Qadri; John P Skendelas; William A Jakobleff; Mirvat Alasnag Journal: Curr Atheroscler Rep Date: 2020-04-23 Impact factor: 5.113
Authors: Alain Combes; Dan Brodie; Yih-Sharng Chen; Eddy Fan; José P S Henriques; Carol Hodgson; Philipp M Lepper; Pascal Leprince; Kunihiko Maekawa; Thomas Muller; Sebastian Nuding; Dagmar M Ouweneel; Antoine Roch; Matthieu Schmidt; Hiroo Takayama; Alain Vuylsteke; Karl Werdan; Laurent Papazian Journal: Intensive Care Med Date: 2017-05-03 Impact factor: 17.440