314: Percutaneous left ventricular assistance in post cardiac arrest shock: comparison of intra aortic blood pump and impella recover LP 2.5

Abstract

To compare the feasibility, safety and outcome of IMPELLA Recover LP2.5 cardiac assistance and intra aortic balloon pump (IABP) in patients with post-cardiac arrest shock. Even after successful resuscitation, the in-hospital survival rate of post-cardiac arrest patients remains very low. Recently, a LV percutaneous mechanical assistance using the IMPELLA Recover LP2.5 has been proposed in order to improve the circulatory abnormalities and to allow further neurological evaluation. Retrospective single center registry performed by the interventional cardiology and intensive care departments. All survivors of out-of-hospital cardiac arrest with patent post-resuscitation shock or predictive factors for the occurrence of shock assisted by either IMPELLA or intra aortic balloon pump (IABP) device immediately after the coronary angiogram were included. 78 post-cardiac arrest patients were assisted (35 by IMPELLA and 43 by IABP). Most of the patients had an acute coronary syndrome as cause of OHCA. Median “no flow” and median “low flow” were similar as hemodynamic parameters at admission. The feasibility (97%) of IMPELLA implantation was very satisfying. At 28 days, the survival rate without sequellae was 23.0% in the IMPELLA group and 29.5% in the IABP group (p=0.61). Post-cardiac arrest shock was the leading cause of death in the IMPELLA group (n= 21). Vascular complication were observed equally in both groups (3 vs 2, p=0.9). Serious bleeding complications requiring tranfusion occurred in 26% of IMPELLA patients vs 9% of IABP patients (p=0.06) and bleeding requiring increase in vasopressor occurred in 9% of patients in both groups. Emergent LV assistance by the IMPELLA LP 2.5 is feasible in patients with post-resuscitation shock. The rate of complication did not differ substantially in the two groups. These encouraging findings must be confirmed in a larger clinical study.