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Impact of left ventricular unloading using a transfemoral micro-axial pump in eCPR patients
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  • Christopher Gaisendrees,
  • Ilija Djordjevic,
  • Anton Sabashnikov,
  • Christoph Adler,
  • Kaveh Eghbalzadeh,
  • Borko Ivanov,
  • Sebastian Walter,
  • Georg Schlachtenberger,
  • Julia Merkle,
  • Ahmed Elderia,
  • Stephen Gerfer,
  • Henning Carstens,
  • Antje Deppe,
  • Elmar W. Kuhn,
  • Thorsten Wahlers
Christopher Gaisendrees
Uniklinik Koln
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Ilija Djordjevic
Uniklinik Koln
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Anton Sabashnikov
University of Cologne
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Christoph Adler
University Hospital Cologne
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Kaveh Eghbalzadeh
Cologne Heart Center
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Borko Ivanov
University Hospital Cologne
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Sebastian Walter
Uniklinik Koln
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Georg Schlachtenberger
Klinikum der Universitat zu Koln Klinik und Poliklinik fur Herz- und Thoraxchirurgie
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Julia Merkle
University Hospital Cologne
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Ahmed Elderia
Uniklinik Koln
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Stephen Gerfer
Klinikum der Universitat zu Koln Klinik und Poliklinik fur Herz- und Thoraxchirurgie
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Henning Carstens
Uniklinik Koln
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Antje Deppe
University of Cologne
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Elmar W. Kuhn
Heart Center, University of Cologne
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Thorsten Wahlers
University Hospital Cologne
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Abstract

Objectives: Extracorporeal cardiopulmonary resuscitation (eCPR) is a rapidly growing treatment strategy due to increasing survival rates in selected patients. Additional left ventricular mechanical unloading, using a transfemoral micro-axial blood pump (Impella®), might improve patients’ outcomes. In this regard, we sought to investigate patients who suffered OHCA (out- of hospital cardiac arrest) or IHCA (in-hospital cardiac arrest) with subsequent eCPR (extracorporeal cardiopulmonary resuscitation) via VA-ECMO (veno-arterial extracorporeal membrane oxygenation) and concomitant Impella® implantation. Methods: From January 2016 until December 2019, 71 patients underwent eCPR at our institution. Data prior eCPR and early outcome parameters were analyzed comparing patients who were supported with an additional transfemoral micro-axial blood pump (ECMO+Impella®, n= 7) and patients without additional (ECMO, n=64) support during VA-ECMO therapy. Results: Baseline data did not significantly differ between groups. All-cause mortality was significantly lower in the ECMO+Impella® group (83% vs. 29%, p= 0.01). The time of circulatory support was shorter in the ECMO+Impella® cohort (3.16±2.09 vs. 6.5±2.79, p=0.01). Additionally, ECMO weaning was significantly more feasible in patients with ECMO+Impella® (71% vs. 29%, p =0.02). Patients treated with additional Impella® showed more acute kidney injury (AKI) with the need for dialysis (71% vs. 21%, p=0.09). Conclusion: From our data, concomitant Impella® support might increase survival and successful ECMO weaning in eCPR patients. Treatment associated complications such as AKI were more common in this highly selected patient group. Further studies with larger numbers are necessary to evaluate concomitant LV-unloading’s clinical relevance in eCPR patients, using an Impella® device.