Abstract 270: Combined Use of VA-ECMO and IMPELLA (ECPELLA) Can Improve Outcomes in Patients Who Underwent E-CPR

Abstract

Background: Extracorporeal CPR (E-CPR) using a veno-arterial ECMO (VA-ECMO) is effective for patients with refractory cardiac arrest. Intra-aortic balloon pumping (IABP) is often combined with VA-ECMO to increase coronary perfusion. However, this combination significantly increases left ventricular afterload. Recent studies showed VA-ECMO combined with IMPELLA pump (ECPELLA) had beneficial effect on refractory cardiogenic shock. Objective: Evaluate outcome of ECPELLA patients who underwent E-CPR as compared to ECMO with IABP. Method: We retrospectively reviewed 140 consecutive patients who underwent E-CPR from January 2012 through May 2020 in our institute. Thirty-eight patients who received ECMO alone were excluded, and 102 patients were recruited. Twenty-four patients underwent ECPELLA (ECPELLA group) and 78 patients underwent ECMO with IABP (IABP group). The 30-day survival rate and the rate of grades 1 and 2 Cerebral Performance Categories (CPC) as the neurological prognosis were assessed. Result: ECPELLA group showed significantly shorter time from cardiac arrest to ECMO placement compared to IABP group (24 min [IQR; 13-41] vs. 49 min [IQR; 28-75]; P=0.0003). The rate of favorable neurological prognosis were significantly higher in the ECPELLA group (38% vs. 13% ; P=0.01). The 30-day all-cause mortality of ECPELLA was significantly lower than IABP (P=0.005 by log-rank test). Multivariate cox proportional hazard analysis including the age, Out of hospital cardiac arrest, shockable rhythm, Acute coronary syndrome, Collaapse-to-ECMO under 60min, and ECPELLA revealed that the age (hazard ratio [HR], 1.34 (10 years increase), 95%CI, 1.11-1.63, P=0.002), Collapse-to-ECMO under 60 min (HR, 0.45, 95%CI, 0.23-0.87, P=0.02) and ECPELLA (HR, 0.48, 95%CI, 0.22-0.95, P=0.035) were significantly associated with 30-day mortality. Conclusion: ECPELLA improves mortality and favorable neurological outcome in patients who underwent E-CPR.