Eastern Cardiothoracic Surgical Society

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Cardiogenic shock patients on VA-ECMO with and without unloading from Impella
Samrah Ansari, Caitlin Hoeing, Sophie Pickering, Alexandra Reph, James K. Wu, MD.
Lehigh Valley Health Network, Allentown, PA, USA.

Background: Patients presenting with cardiogenic shock can be treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for full cardiopulmonary support. This can be a bridge to further treatment, providing more time for a decision. However, due to the retrograde aortic flow from the arterial cannula, there is an afterload on the left ventricle. In these cases, a heart device can be placed in the left heart, known as a left ventricular assist device (LVAD) for further ejection of blood.Methods: Here, we retrospectively observed the charts of 129 unmatched patients on VA-ECMO. 104 patients were observed to be on VA-ECMO alone, while 25 were apart of a VA-ECMO and Impella cohort. Patients charts were analyzed for demographics, outcomes, secondary outcomes, and risk factors. Data was then analyzed using descriptive statistics.Results: We found both groups had a similar survival rate of 40% to discharge. We observed there to be a higher mortality rate among those who had renal failure before undergoing VA-ECMO. Conclusion: While the Impella device did not show any profound benefit for its use, our results are limited in the sample size and unmatched patient comparison. More research needs to be done looking specifically at patients with renal issues going on Impella.


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