Impella CP Implantation during Cardiopulmonary Resuscitation for Cardiac Arrest: A Multicenter Experience.

Vassili Panagides,Jose P S Henriques,Steffen Christensen,Hayaan Kamran,Julien Mancini,Hans Eiskjær,Marc Laine,Supria Batra,Mir B Basir,Franck Paganelli,Henrik Vase,Mina Karami,Laurent Bonello,Sachin P Shah

doi:10.3390/jcm10020339

Abstract

Background: Impella CP is a left ventricular pump which may serve as a circulatory support during cardiopulmonary resuscitation (CPR) for cardiac arrest (CA). Nevertheless, the survival rate and factors associated with survival in patients undergoing Impella insertion during CPR for CA are unknown. Methods: We performed a retrospective multicenter international registry of patients undergoing Impella insertion during on-going CPR for in- or out-of-hospital CA. We recorded immediate and 30-day survival with and without neurologic impairment using the cerebral performance category score and evaluated the factors associated with survival. Results: Thirty-five patients had an Impella CP implanted during CPR for CA. Refractory ventricular arrhythmias were the most frequent initial rhythm (65.7%). In total, 65.7% of patients immediately survived. At 30 days, 45.7% of patients were still alive. The 30-day survival rate without neurological impairment was 37.1%. In univariate analysis, survival was associated with both an age < 75 years and a time from arrest to CPR ≤ 5 min (p = 0.035 and p = 0.008, respectively). Conclusions: In our multicenter registry, Impella CP insertion during ongoing CPR for CA was associated with a 37.1% rate of 30-day survival without neurological impairment. The factors associated with survival were a young age and a time from arrest to CPR ≤ 5 min.

Highlights

Sudden cardiac arrest (CA) is a major cause of death worldwide [1]
Extended cardiopulmonary resuscitation (CPR) was required following Impella start in 48.6% of patients
The Impella CP registry suggests that the early implantation of an Impella CP during ongoing-CPR for CA related to acute coronary syndrome (ACS) is feasible and is associated with a 30-day survival rate of 45.7% and 37.1% without neurological sequelae

Summary

Introduction

Sudden cardiac arrest (CA) is a major cause of death worldwide [1]. Survival following cardiopulmonary resuscitation (CPR) remains limited and the overall rate of survival to hospital discharge is about 10% for both in-hospital and out-of-hospital CA [2,3,4,5]. Case reports and monocenter registries have suggested a potential role for Impella CP in the setting of CA [12,13,14] In these reports, the inclusion criteria and survival rates were variable, the sample size was limited, and predictors of success could not be determined. Impella CP is a left ventricular pump which may serve as a circulatory support during cardiopulmonary resuscitation (CPR) for cardiac arrest (CA). The survival rate and factors associated with survival in patients undergoing Impella insertion during CPR for CA are unknown. Conclusions: In our multicenter registry, Impella CP insertion during ongoing CPR for CA was associated with a 37.1% rate of 30-day survival without neurological impairment. The factors associated with survival were a young age and a time from arrest to CPR ≤ 5 min

Methods

Results

Conclusion