Abstract
Background
In refractory cardiogenic shock, temporary mechanical support (tMCS) may be crucial for maintaining tissue perfusion and oxygen delivery. tMCS can serve as a bridge-to-decision to assess eligibility for left ventricular assist device (LVAD) implantation or heart transplantation, or as a bridge-to-recovery. ECPELLA is a novel tMCS configuration combining venoarterial extracorporeal membrane oxygenation with Impella. The present study presents the clinical parameters, outcomes, and complications of patients supported with ECPELLA.
Methods
All patients supported with ECPELLA at University Medical Centre Utrecht between December 2020 and August 2023 were included. The primary outcome was 30-day mortality, and secondary outcomes were LVAD implantation/heart transplantation and safety outcomes.
Results
Twenty patients with an average age of 51 years, and of whom 70% were males, were included. Causes of cardiogenic shock were acute heart failure (due to acute coronary syndrome, myocarditis, or after cardiac surgery) or chronic heart failure, respectively 70 and 30% of cases. The median duration of ECPELLA support was 164 h (interquartile range 98–210). In 50% of cases, a permanent LVAD was implanted. Cardiac recovery within 30 days was seen in 30% of cases and 30-day mortality rate was 20%. ECPELLA support was associated with major bleeding (40%), haemolysis (25%), vascular complications (30%), kidney failure requiring replacement therapy (50%), and Impella failure requiring extraction (15%).
Conclusion
ECPELLA can be successfully used as a bridge to LVAD implantation or as a bridge-to-recovery in patients with refractory cardiogenic shock. Despite a significant number of complications, 30-day mortality was lower than observed in previous cohorts.
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Details
1 University Medical Centre Utrecht, Department of Cardiology, Utrecht, The Netherlands (GRID:grid.7692.a) (ISNI:0000 0000 9012 6352)
2 Erasmus Medical Centre, Department of Cardiology, Rotterdam, The Netherlands (GRID:grid.5645.2) (ISNI:000000040459992X); Erasmus Medical Centre, Department of Intensive Care, Rotterdam, The Netherlands (GRID:grid.5645.2) (ISNI:000000040459992X)
3 University Medical Centre Utrecht, Department of Cardiothoracic Surgery, Utrecht, The Netherlands (GRID:grid.7692.a) (ISNI:0000 0000 9012 6352)
4 University Medical Centre Utrecht, Department of Intensive Care, Utrecht, The Netherlands (GRID:grid.7692.a) (ISNI:0000 0000 9012 6352)
5 University Medical Centre Utrecht, Department of Anaesthesiology, Utrecht, The Netherlands (GRID:grid.7692.a) (ISNI:0000 0000 9012 6352)
6 University Medical Centre Utrecht, Department of Intensive Care, Utrecht, The Netherlands (GRID:grid.7692.a) (ISNI:0000 0000 9012 6352); University of Twente, Cardiovascular and Respiratory Physiology, Tech Med Centre, Enschede, The Netherlands (GRID:grid.6214.1) (ISNI:0000 0004 0399 8953)