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- Title
ECPELLA as a bridge-to-decision in refractory cardiogenic shock: a single-centre experience.
- Authors
Balder, Jan-Willem; Szymanski, Mariusz K.; van Laake, Linda W.; van der Harst, Pim; Meuwese, Christiaan L.; Ramjankhan, Faiz Z.; van der Meer, Manon G.; Hermens, Jeannine A. J. M.; Voskuil, Michiel; de Waal, Eric E. C.; Donker, Dirk W.; Oerlemans, Marish I. F. J.; Kraaijeveld, Adriaan O.
- 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.
- Subjects
CARDIOGENIC shock; HEART assist devices; EXTRACORPOREAL membrane oxygenation; ACUTE coronary syndrome; HEART failure
- Publication
Netherlands Heart Journal, 2024, Vol 32, Issue 6, p245
- ISSN
1568-5888
- Publication type
Article
- DOI
10.1007/s12471-024-01872-w