Objectives: Implanting venoarterial extracorporeal membrane oxygenation (VA-ECMO) in cardiogenic
shock allows patient bridging to decision. Left ventricular (LV) unloading is needed
in patients with LV akinesia, developing pulmonary edema or LV thrombosis. An Impella
(IP) is used for unloading the left ventricle in inotrope refractory akinesia. In
patients treated with the combination of VA-ECMO and IP, we sought to determine clinical
variables associated to 30-day mortality.
Methods: A total of 75 patients underwent concomitant treatment with VA-ECMO and IP at our
center. VA-ECMO was implanted via the groin. IP was placed via the femoral (n = 70) or subclavian artery (n = 5). We present result of all patients surviving a minimum of 24 hours on VA-ECMO/IP
support. Another nine patients died within 24 hours after implantation and remained
excluded.
Results: Cardiogenic shock resulted from AMI in 24 patients (32%), postcardiotomy syndrome
in 13 (17%), CHF in 25 (33%), and miscellaneous causes in 13 (17%). A 30-day mortality
was 44% (n = 33) and median survival 27.6 ± 9.4 months. Causes of death consisted of multiple
organ failure (49%), neurologic injury (28%), refractory myocardial insufficiency
(19%), and respiratory failure (4%). Mean VA-ECMO/IP support time was 6.7 (1–21) days.
Twenty-six patients (35%) recovered myocardial function and 23 patients (31%) were
bridged to a long-term VAD. Two patients (3%) underwent HTX. Age, body mass index,
renal failure, increased serum lactate, and LV stasis were independent predictors
for death (p < 0.05, each).
Conclusion: Concomitant VA-ECMO/IP support achieved LV unloading in all patients allowing bridging
to recovery or definite therapy in a relevant patient proportion. Hence, it might
improve outcome in presence of LV congestion on peripheral VA-ECMO.
