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Concomitant Use of VA-ECMO and Impella Support for Cardiogenic Shock
Preprint   Open access

Concomitant Use of VA-ECMO and Impella Support for Cardiogenic Shock

Shan P Modi, Yeahwa Hong, McKenzie M Sicke, Nicholas R Hess, Wyatt J Klass, Luke A Ziegler, Ryan M Rivosecchi, Gavin W Hickey, David J Kaczorowski and Raj Ramanan
medRxiv : the preprint server for health sciences
27 Jul 2023
DOI: https://doi.org/10.1101/2023.07.24.23293127
PMID: 37546750
url
https://doi.org/10.1016/j.xjon.2023.12.005View
Published, Version of Record (VoR)CC BY-NC-ND V4.0,  Open

Abstract

Shock ECpella Cardiogenic ADHF-CS AMI-CS
VA-ECMO with concomitant Impella support (ECpella) is an emerging treatment modality for cardiogenic shock (CS). Survival outcomes by CS etiology with ECpella support have not been well-described. This study was a retrospective, single-center analysis of patients with cardiogenic shock due to acute myocardial infarction (AMI-CS) or decompensated heart failure (ADHF-CS) supported with ECpella from December 2020 to January 2023. Primary outcomes included 90-day survival post-discharge and destination after support. Secondary outcomes included complications post-ECpella support. A total of 44 patients were included (AMI-CS, = 20, and ADHF-CS, = 24). Patients with AMI-CS and ADHF-CS had similar survival 90 days post-discharge ( = .267) with similar destinations after ECpella support ( = .220). Limb ischemia and acute kidney injury occurred more frequently in patients presenting with AMI-CS ( 013; = .030). Patients with initial Impella support were more likely to survive ECpella support and be bridged to transplant ( =.033) and less likely to have a cerebrovascular accident =.016). Sub-analysis of ADHF-CS patients into acute-on-chronic decompensated heart failure and de novo heart failure demonstrated no difference in survival or destination. ECpella can be used to successfully manage patients with CS. There is no difference in survival or destination for AMI-CS and ADHF-CS in patients with ECpella support. Patients with initial Impella support are more likely to survive ECpella support and bridge to transplant. Future multicenter studies are required to fully analyze the differences between AMI-CS and ADHF-CS with ECpella support.

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