Three Cases of LMT-STEMI with Cardiogenic Shock Under ECPELLA Support with Different Levels of Left Ventricular Unloading

Abstract

Acute myocardial infarction with cardiogenic shock (AMICS) has an extremely high mortality rate, despite the development of early reperfusion strategies and intensive cardiovascular care medicine. In most cases, residual damage to the left ventricular (LV) damage induces refractory heart failure, even after successful salvage from cardiac arrest and shock conditions in the acute phase. We herein report three cases of AMICS that were supported by a combination of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and the Impella percutaneous microaxial heart pump, collectively referred to as ECPELLA. The first case was supported by an Impella CP pump prior to percutaneous coronary intervention (PCI), followed by ECPELLA. After PCI, the Impella was upgraded to an Impella 5.0. However, the LV function did not recover [LV ejection fraction (LVEF) 24%], and the patient died due to intestinal ischemia. The second case was supported by VA-ECMO prior to PCI, followed by ECPELLA. The LV function did not recover (LVEF 25%), and the patient was transferred to the ventricular assist device/heart transplant center. The third case received ECPELLA prior to PCI. The patient was successfully weaned from VA-ECMO and Impella support. The LVEF recovered to 39%, and the patient was discharged from the hospital on day 47. Although all three patients were supported by ECPELLA in the acute phase, the LV load during PCI differed markedly among the three cases. ECPELLA, which provides sufficient systemic perfusion with total LV unloading, may contribute to myocardial protection in AMICS.