Abstract
BackgroundPercutaneous mechanical circulatory devices are increasingly used in patients with cardiogenic shock (CS). As evidence from randomized studies comparing these devices are lacking, optimal choice of the device type is unclear. Here we aim to compare outcomes of patients with CS supported with either Impella or vaECMO.MethodsRetrospective single-center analysis of patients with CS, from September 2014 to September 2019. Patients were assisted with either Impella 2.5/CP or vaECMO. Patients supported ultimately with both devices were analyzed according to the first device implanted. Primary outcomes were hospital and 6-month survival. Secondary endpoints were complications. Survival outcomes were compared using propensity-matched analysis to account for differences in baseline characteristics between both groups.ResultsA total of 423 patients were included (Impella, n = 300 and vaECMO, n = 123). Survival rates were similar in both groups (hospital survival: Impella 47.7% and vaECMO 37.3%, p = 0.07; 6-month survival Impella 45.7% and vaECMO 35.8%, p = 0.07). There was no significant difference in survival rates, even after adjustment for baseline differences (hospital survival: Impella 50.6% and vaECMO 38.6%, p = 0.16; 6-month survival Impella 45.8% and vaECMO 38.6%, p = 0.43). Access-site bleeding and leg ischemia occurred more frequently in patients with vaECMO (17% versus 7.3%, p = 0.004; 17% versus 7.7%, p = 0.008).ConclusionsIn this retrospective analysis of patients with CS, treatment with Impella 2.5/CP or vaECMO was associated with similar hospital and 6-month survival rates. Device-related access-site vascular complications occurred more frequently in the vaECMO group. A randomized trial is warranted to examine the effects of these devices on outcomes and to determine the optimal device choice in patients with CS.
Highlights
Despite the increased use of evidence-based medicine and interventions, cardiogenic shock (CS) still portends unacceptably high hospital mortality rates
Percutaneous mechanical circulatory support (MCS) devices are increasingly used in patients with CS, in order to restore hemodynamics, improve cardiac output and ensure adequate end-organ perfusion [1]
Forty-two (9.9%) patients were supported by both devices simultaneously (20 patients Impella first and 22 patients venoarterial extracorporeal membrane oxygenation (vaECMO) first)
Summary
Despite the increased use of evidence-based medicine and interventions, CS still portends unacceptably high hospital mortality rates. Despite the growth in the use of vaECMO and Impella to support patients with CS, no randomized trials have compared the efficacy of these devices in patients with CS. The aim of this retrospective study was to compare outcomes of patients with CS supported with either Impella (2.5/CP) or vaECMO. We aim to compare outcomes of patients with CS supported with either Impella or vaECMO. Survival rates were similar in both groups (hospital survival: Impella 47.7% and vaECMO 37.3%, p = 0.07; 6-month survival Impella 45.7% and vaECMO 35.8%, p = 0.07). Conclusions In this retrospective analysis of patients with CS, treatment with Impella 2.5/CP or vaECMO was associated with similar hospital and 6-month survival rates. Device-related access-site vascular complications occurred more frequently in the vaECMO group. A randomized trial is warranted to examine the effects of these devices on outcomes and to determine the optimal device choice in patients with CS
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