title: Concomitant implantation of Impella®on top of veno-arterial extracorporeal membrane oxygenation may improve survival of patients with cardiogenic shock.
abstract: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support stabilizes patients with cardiogenic shock. Despite improved oxygenation and peripheral circulation, LV unloading may be impeded due to the increased afterload, resulting in a failing static left ventricle and in high mortality.
  
  
  
  We describe for the first time a large series of patients treated with the combination of VA-ECMO and Impella®compared with patients with VA-ECMO only. We retrospectively collected data on patients from two tertiary critical care referral centres. We enrolled 157 patients treated with VA-ECMO from January 2013 to April 2015: 123 received VA-ECMO support and 34 had concomitant treatment with VA-ECMO and Impella. A propensity-matching analysis was performed in a 2:1 ratio, resulting in 42 patients undergoing VA-ECMO alone (control group) compared with 21 patients treated with VA-ECMO and Impella. Patients in the VA-ECMO and Impella group had a significantly lower hospital mortality (47% vs. 80%, P < 0.001) and a higher rate of successful bridging to either recovery or further therapy (68% vs. 28%, P < 0.001) compared with VA-ECMO patients. A higher need for continuous veno-venous haemofiltration (48% vs. 19%, P = 0.02) and increased haemolysis (76% vs. 33%, P = 0.004) were reported in the study group due to higher survival. There was no difference in major bleeding rates between the two groups (VA-ECMO and Impella 38% vs. VA-ECMO 29%, P = 0.6).
  
  
  
  Concomitant treatment with VA-ECMO and Impella may improve outcome in patients with cardiogenic shock compared with VA-ECMO only. Nevertheless, randomized studies are needed to validate these promising results further.
authors.affiliation: Department of Cardiothoracic Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Vita Salute University, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Pappalardo
authors.affiliation: Department of General and Interventional Cardiology, University Heart Centre Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schulte
authors.affiliation: Department of Cardiothoracic Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Vita Salute University, Milan, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Pieri
authors.affiliation: Department of General and Interventional Cardiology, University Heart Centre Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Schrage
authors.affiliation: Department of Interventional Cardiology, IRCCS San Raffaele Scientific Institute, Vita Salute University, Milan, Italy.
authors.forename: Rachele
authors.initials: R
authors.lastname: Contri
authors.affiliation: Department of Intensive Care, Centre for Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Gerold
authors.initials: G
authors.lastname: Soeffker
authors.affiliation: Department of Cardiothoracic Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Vita Salute University, Milan, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Greco
authors.affiliation: Department of Cardiothoracic Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Vita Salute University, Milan, Italy.
authors.forename: Rosalba
authors.initials: R
authors.lastname: Lembo
authors.affiliation: Department of General and Interventional Cardiology, University Heart Centre Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Müllerleile
authors.affiliation: Department of Interventional Cardiology, IRCCS San Raffaele Scientific Institute, Vita Salute University, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.affiliation: Department of General and Interventional Cardiology, University Heart Centre Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Sydow
authors.affiliation: Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Vita Salute University, Milan, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: De Bonis
authors.affiliation: Department of Cardiovascular Surgery, University Heart Centre Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Wagner
authors.affiliation: Department of Cardiovascular Surgery, University Heart Centre Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Reichenspurner
authors.affiliation: Department of General and Interventional Cardiology, University Heart Centre Hamburg Eppendorf, Hamburg, Germany.|German Centre for Cardiovascular Research (DZHK), Partner site Hamburg/Lübeck/Kiel, Hamburg, Gemany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.affiliation: Department of Cardiothoracic Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Vita Salute University, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
authors.affiliation: Department of General and Interventional Cardiology, University Heart Centre Hamburg Eppendorf, Hamburg, Germany.|German Centre for Cardiovascular Research (DZHK), Partner site Hamburg/Lübeck/Kiel, Hamburg, Gemany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Westermann
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000628:therapy*; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000628:therapy*
keywords: Extracorporeal circulation; Heart failure; Heart-assist device; Percutaneous left ventricular assist device; Shock