ECPELLA as abridge-to-decision in refractory cardiogenic shock: asingle-centre experience.

Abstract

In refractory cardiogenic shock, temporary mechanical support (tMCS) may be crucial for maintaining tissue perfusion and oxygen delivery. tMCS can serve as abridge-to-decision to assess eligibility for left ventricular assist device (LVAD) implantation or heart transplantation, or as abridge-to-recovery. ECPELLA is anovel tMCS configuration combining venoarterial extracorporeal membrane oxygenation with Impella. The present study presents the clinical parameters, outcomes, and complications of patients supported with ECPELLA. All patients supported with ECPELLA at University Medical Centre Utrecht between December 2020 and August 2023 were included. The primary outcome was 30-day mortality, and secondary outcomes were LVAD implantation/heart transplantation and safety outcomes. Twenty patients with an average age of 51years, and of whom 70% were males, were included. Causes of cardiogenic shock were acute heart failure (due to acute coronary syndrome, myocarditis, or after cardiac surgery) or chronic heart failure, respectively 70and 30% of cases. The median duration of ECPELLA support was 164 h (interquartile range 98-210). In 50% of cases, apermanent LVAD was implanted. Cardiac recovery within 30days was seen in 30% of cases and 30-day mortality rate was 20%. ECPELLA support was associated with major bleeding (40%), haemolysis (25%), vascular complications (30%), kidney failure requiring replacement therapy (50%), and Impella failure requiring extraction (15%). ECPELLA can be successfully used as abridge to LVAD implantation or as abridge-to-recovery in patients with refractory cardiogenic shock. Despite asignificant number of complications, 30-day mortality was lower than observed in previous cohorts.