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Benefits of Impella and Peripheral Veno-Arterial Extra Corporeal Life Support Alliance

Colombier, S.*; Quessard, A.*; Mastroianni, C.*; Schmidt, M.; Amour, J.*; Leprince, P.*; Lebreton, G.*

doi: 10.1097/MAT.0000000000000922
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Peripheral veno-arterial extra corporeal life support (V-A ECLS) is an effective tool in treating refractory cardiogenic shock (RCS). Despite additional use of intra-aortic balloon pump, insufficient left ventricular unloading is a likely complication. We present herein our experience combining V-A ECLS and Impella to treat symptomatic, critical patients. A retrospective single-center review analyzed patients with V-A ECLS and intra-aortic balloon pump for RCS and subsequently benefiting from Impella implantation, between 2011 and 2015. From 1248 cases, 31 critical patients (2.5%) with a median SOFA score = 12 (7–15) were included. Median age was 53 years, and 74% were male. RCS resulted from myocardial ischemia (52%) and idiopathic dilated myocardiopathy (23%). Forty-seven percentage of patients were treated previously for chronic Heart Failure with reduced Ejection Fraction (HFrEF). Median time between V-A ECLS and Impella implantation was 84 hours (24–186). The Impella median support duration was 8 days (5–10). ECLS and Impella were weaned simultaneously in 26% of patients, 33% were switched to a long-term assistance, and 10% were transplanted. Overall, day-30 survival was 53%. Factors including diabetes, patients aged over 60 years, surgery using extracorporeal circulation, adrenalin infusion, acute myocardial infarction, and chronic HFrEF are associated with day-30 mortality. Chronic HFrEF was an independent risk factor for the day-30 mortality [hazard ratio = 5.28 (1.38–20.21), P = 0.015]. Impella and V-A ECLS combination is a promising association for critical patients presenting symptomatic insufficient LV unloading, for weaning V-A ECLS or testing the right ventricle before a switch to left ventricle assist device support.

From the *Cardio-thoracic Surgery Department

Intensive Care Unit, La Pitié Salpêtrière University Hospital, Assistance Publique - Hôpitaux de Paris, France.

Submitted for consideration March 2018; accepted for publication in revised form October 2018.

Disclosure: The authors have no conflicts of interest to report.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Correspondence: Sébastien Colombier, Cardio-thoracic Surgery Department, La Pitié Salpêtrière University Hospital, 47–83 Bd de l’Hôpital, 75651 Paris Cedex 13. Email: sebastien.colombier@hopitalvs.ch.

Copyright © 2019 by the American Society for Artificial Internal Organs