Table 2.
Outcome of combined Impella and VA ECMO support in cardiogenic shock
| Author | Description | Results |
|---|---|---|
| Tepper 2017 | Single-center study | 30-day survival (p = 0.42): |
| 23 patients with Impella + VA ECMO compared to 22 VA ECMO + surgical vent | Impella + VA ECMO 43% | |
| VA ECMO + surgical vent 32% | ||
| Pappalardo 2017 | Multi-center study | Hospital mortality: |
| 34 Impella + VA ECMO compared to 123 VA ECMO | Impella + VA ECMO 47% vs. VA ECMO 80% (p < 0.001) | |
| Successful bridging to recovery or next therapy: | ||
| Propensity matched cohort | ||
| Impella + VA ECMO 68% vs. VA ECMO 28% (p < 0.001) | ||
| 21 Impella + VA ECMO compared to 42 VA ECMO | ||
| Propensity matched: | ||
| Impella + VA ECMO 48% vs. VA ECMO 74% (p = 0.04) | ||
| Higher rates of hemolysis (76 vs. 33%, p = 0.004) and CVVH (48 vs. 19%, p = 0.02) in the Impella + VA ECMO group | ||
| Colombier 2018 | Single-center study | Median time to Impella 84 (24–186) h |
| 31 patients with refractory shock despite VA ECMO and IABP | ||
| Median Impella support 8 (5–10) days | ||
| 30-day survival 53% | ||
| Median age 53 years, 74% males | HFREF independent risk factor for 30-day mortality | |
| Akanni 2018 | Single-center study | 30-day survival (p = 0.913): |
| 15 from Impella to Impella + VA ECMO | Impella to Impella + VA ECMO 46.7% | |
| VA ECMO to Impella + VA ECMO 42.9% | ||
| 14 from VA ECMO to Impella + VA ECMO | VA ECMO alone 49% | |
| Compared to 196 patients supported on VA ECMO | ||
| Schrage 2018 | Single-center study | 21% Impella first, 19% VA ECMO first, 60% implanted simultaneously (59% CPR) |
| 106 consecutive patients | Impella CP in 83 (78%), Impella 2.5 in 23 (22%) | |
| 38 survivors and 68 non-survivors at 30 days | 12 patients (22%) upgraded from Impella CP to Impella 5.0 | |
| Median duration of VA ECMO support: 6 (3–10) days | ||
| Median duration of Impella support: 6 (3–12) days | ||
| 12 patients bridged to durable LVAD, no patients bridged to transplantation | ||
| 30-day mortality 64% | ||
| Patel 2019 | Single-center study | Surgical venting in 21 (58%) of VA ECMO patients |
| 30 patients with Impella + VA ECMO compared to 36 patients with VA ECMO | ||
| 30-day survival: Impella + VA ECMO 43% vs. VA ECMO 22% (p = 0.02) |