Impact of left ventricular unloading using a transfemoral micro-axial
pump in eCPR patients
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.