Benefits of Impella and Peripheral Veno-Arterial Extra Corporeal Life Support Alliance. Issue 8 (November 2019)
- Record Type:
- Journal Article
- Title:
- Benefits of Impella and Peripheral Veno-Arterial Extra Corporeal Life Support Alliance. Issue 8 (November 2019)
- Main Title:
- Benefits of Impella and Peripheral Veno-Arterial Extra Corporeal Life Support Alliance
- Authors:
- Colombier, Sébastien
Quessard, Astrid
Mastroianni, Ciro
Schmidt, Matthieu
Amour, Julien
Leprince, Pascal
Lebreton, Guillaume - Abstract:
- Abstract : 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 ratioAbstract : 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. Abstract : Supplemental Digital Content is available in the text. … (more)
- Is Part Of:
- ASAIO journal. Volume 65:Issue 8(2019)
- Journal:
- ASAIO journal
- Issue:
- Volume 65:Issue 8(2019)
- Issue Display:
- Volume 65, Issue 8 (2019)
- Year:
- 2019
- Volume:
- 65
- Issue:
- 8
- Issue Sort Value:
- 2019-0065-0008-0000
- Page Start:
- Page End:
- Publication Date:
- 2019-11
- Subjects:
- Impella -- veno-arterial ECMO -- ECLS -- refractory cardiogenic shock -- left ventricle unloading
Artificial organs -- Periodicals
617 - Journal URLs:
- http://journals.lww.com/asaiojournal/pages/default.aspx ↗
http://journals.lww.com ↗ - DOI:
- 10.1097/MAT.0000000000000922 ↗
- Languages:
- English
- ISSNs:
- 1058-2916
- Deposit Type:
- Legaldeposit
- View Content:
- Available online (eLD content is only available in our Reading Rooms) ↗
- Physical Locations:
- British Library DSC - 1738.840500
British Library DSC - BLDSS-3PM
British Library STI - ELD Digital store - Ingest File:
- 17137.xml