Abstract 381: Simultaneous Use of VA-ECMO and Impella (ECPELLA) Improves Mid-Term Mortality in Patients With Refractory Cardiac Arrest or Cardiac Shock Who Required VA-ECMO
Taiji Inamori, Takashi Unoki, Tomoko Nakayama, Toshiki Fukuda, Takaaki Toyofuku, Junya Matsura, Yutaka Konami, Hiroto Suzuyama, Masayuki Inoue, Eiji Horio, Kazuhisa Kodama, Eiji Taguchi, Tadashi Sawamura, Tomohiro Sakamoto, Koichi Nakao, Jyunjiro Koyama- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an effective therapy to rescue patients with refractory cardiogenic shock, including cardiac arrest. VA-ECMO increase damaged left ventricular (LV) afterload. The intra-aortic balloon pump (IABP) has been often used as the additional circulatory support for LV unloading. However, the effectiveness of combining VA-ECMO with IABP has not been definitively established. The Impella , a percutaneous micro-axial pump, can reduce damaged LV preload with circulatory support, which may have significant effect on clinical outcome by concomitant use of VA-ECMO and Impella (ECPELLA).
Objective: This single-site cohort study aimed to assess the impact of ECPELLA compared to VA-ECMO with or without IABP in patients with refractory cardiogenic shock who received VA-ECMO treatment.
Methods: We retrospectively reviewed 275 consecutive patients who received VA-ECMO from January 2012 through December 2022 in our institute. The patients were divided into two groups, ECEPLLA (n = 81) and VA-ECMO with or without IABP (n = 194). The primary outcome of this study was the 180-day all-cause mortality rate.
Results: There were no significant differences in age, gender ratio, prevalence of coronary risk factors, serum lactate levels at the emergency room (ER), the rate of extracorporeal cardiopulmonary resuscitation (E-CPR), and instances of out-of-hospital cardiac arrest between the groups. The ECPELLA groups had a significantly higher rate of acute coronary syndrome and a lower prevalence of chronic kidney disease. Kaplan-Meier analysis demonstrated that the 180-day all-cause mortality was significantly lower in the ECPELLA group compared to the VA-ECMO group (p < 0.001). Multivariate cox proportional hazard analysis revealed that age (hazard ratio [HR], 1.27 [10 years increase]; 95% confidence interval [CI], 1.13-1.42, p < 0.001), E-CPR (HR 1.43; 95% CI 1.02-2.00, p = 0.04), lactate level at ER (HR 1.07; 95% CI 1.04-1.10, p < 0.001), and ECPELLA (HR, 0.55, 95% CI, 0.40-0.76, p < 0.001) were significantly associated with the 180-day all-cause mortality.
Conclusion: ECPELLA was associated with improvement of mid-term mortality in patients with refractory cardiogenic shock who received VA-ECMO.