Percutaneous left ventricular assistance in post cardiac arrest shock: Comparison of intra aortic blood pump and IMPELLA Recover LP2.5

Abstract

AimTo 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. BackgroundThe high early mortality rate of post-cardiac arrest patients is attributed to a “post cardiac arrest syndrome” characterized by an acute and transient left ventricular (LV) systolic dysfunction. LV assistance with IMPELLA Recover LP2.5 is proposed in most severe patients. MethodsRetrospective single center registry from January 2007 to October 2010. All survivors of out-of-hospital cardiac arrest with patent or predictive factors for the occurrence of post-resuscitation shock assisted by either IMPELLA or intra aortic balloon pump (IABP) device immediately after the coronary angiogram were included. Results78 post-cardiac arrest patients were assisted by one of the devices (35 by IMPELLA and 43 by IABP). Median “no flow” and median “low flow” were similar at admission as were hemodynamic parameters. The feasibility of IMPELLA implantation was good (97%). At 28 days, the survival rate without sequellae was 23.0% in the IMPELLA and 29.5% in the IABP group (p=0.61). Vascular complications were observed equally in both groups (3 vs 2, p=0.9). Serious bleeding complications occurred in 26% of IMPELLA patients vs 9% of IABP patients (p=0.06). ConclusionEarly LV assistance by the IMPELLA LP2.5 is feasible in patients with post-resuscitation shock. The rate of complications did not differ substantially in the two groups, except for a trend toward a higher rate of bleeding events with IMPELLA. These encouraging findings must be confirmed in a larger clinical study.