ECPella: Concept, Physiology and Clinical Applications

Meani, Paolo; Lorusso, Roberto; Pappalardo, Federico

doi:10.1053/j.jvca.2021.01.056

Cited by 36 publications

(24 citation statements)

References 59 publications

(53 reference statements)

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“…No.) 1, 3 and 4 in Table 1 ] required ECMO support in addition to Impella support (ECPELLA) [ 19 , 20 ]. In all the 3 patients, veno-arterial ECMO support was added after the initiation of Impella support because of inadequate Impella support due to right heart failure (elevated central venous pressure, inadequate Impella flow, and frequent suction event).…”

Section: Resultsmentioning

confidence: 99%

Impella support as a bridge to heart surgery in patients with cardiogenic shock

Saito

Shibasaki

Matsuoka

et al. 2022

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES In patients with cardiogenic shock, delayed surgery after stabilization of haemodynamics and improvement in end-organ function by mechanical circulatory support is known to yield better outcomes than emergency surgery. We aimed to investigate the effectiveness of Impella (Abiomed, Danvers, MA, USA) as a bridge to cardiac surgery in patients with cardiogenic shock. METHODS We reviewed 7 patients with cardiogenic shock who underwent Impella support as a bridge to cardiac surgery using cardiopulmonary bypass at our institution between April 2018 and August 2021. RESULTS Cardiogenic shock was caused by ventricular septal rupture in 3 patients, papillary muscle rupture in 1 and acute myocardial infarction in 3. Cardiac surgery was delayed by 1–7 (3.9 ± 2.5) days with Impella support after the diagnosis of cardiogenic shock, during which the hepatic and renal function of the patients improved significantly. Device-related or operation-related adverse events included re-exploration for bleeding in 3 patients, acute limb ischaemia due to thromboembolism in 1 and intraoperative aortic dissection in 1. Thirty-day mortality was 14.3%, and the cumulative survival was 71.4% at 1 year. The survival tended to be better than that in historical control group in which extracorporeal membrane oxygenation was used as a bridge to surgery (P = 0.0992). CONCLUSIONS Impella is an effective tool for bridging patients with cardiogenic shock to surgery. This strategy may improve surgical outcomes in patients with cardiogenic shock. However, prolonged Impella support may increase significant adverse events, and further investigation is required to determine the optimal duration of support before surgery.

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Section: Resultsmentioning

confidence: 99%

Impella support as a bridge to heart surgery in patients with cardiogenic shock

Saito

Shibasaki

Matsuoka

et al. 2022

Interactive CardioVascular and Thoracic Surgery

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“…ECMELLA/ECPELLA) has recently gained strong attention. 30 , 31 , 32 , 33 , 34 In most of these studies, the mortality risk was reduced when unloading was added, yet the high rates of complications make its routine applicability dubious. At present, there is still a lack of a randomized controlled trial (RCT) comparing these strategies to define the time of implantation and the ideal clinical scenario.…”

Section: Discussionmentioning

confidence: 99%

Time course, factors related to, and prognostic impact of venoarterial extracorporeal membrane flow in cardiogenic shock

et al. 2022

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Aims Venoarterial extracorporeal membrane oxygenation (VA‐ECMO) is currently one of the most used devices in refractory cardiogenic shock. However, there is a lack of evidence on how to set the ‘optimal’ flow. We aimed to describe the evolution of VA‐ECMO flows in a cardiogenic shock population and determine the risk factors of ‘high‐ECMO flow’. Methods and results A 7 year database of patients supported with VA‐ECMO was used. Based on the median flow during the first 48 h of the VA‐ECMO run, patients were classified as ‘high‐flow’ or ‘low‐flow’, respectively, when median ECMO flow was ≥3.6 or <3.6 L/min. Outcomes included rates of ventilator‐associated pneumonia, ECMO‐related complications, days on ECMO, days on mechanical ventilation, intensive care unit and hospitalization lengths of stay, and in‐hospital and 60 day mortality. Risk factors of high‐ECMO flow were assessed using univariate and multivariate cox regression. The study population included 209 patients on VA‐ECMO, median age was 51 (40–59) years, and 78% were males. The most frequent aetiology leading to cardiogenic shock was end‐stage dilated cardiomyopathy (57%), followed by acute myocardial infarction (23%) and fulminant myocarditis (17%). Among the 209 patients, 105 (50%) were classified as ‘high‐flow’. This group had a higher rate of ischaemic aetiology (16% vs. 30%, P = 0.023) and was sicker at admission, in terms of worse Simplified Acute Physiology Score II score [40 (26–58) vs. 56 (42–74), P < 0.001], higher lactate [3.6 (2.2–5.8) mmol/L vs. 5.2 (3–9.7) mmol/L, P < 0.001], and higher aspartate aminotransferase [97 (41–375) U/L vs. 309 (85–939) U/L, P < 0.001], among others. The ‘low‐flow’ group had less ventilator‐associated pneumonia (40% vs. 59%, P = 0.007) and less days on mechanical ventilation [4 (1.5–7.5) vs. 6 (3–12) days, P = 0.009]. No differences were found in lengths of stay or survival according to the ECMO flow. The multivariate analysis showed that risk factors independently associated with ‘high‐flow’ were mechanical ventilation at cannulation [odds ratio (OR) 3.9, 95% confidence interval (CI) 2.1–7.1] and pre‐ECMO lactate (OR 1.1, 95% CI 1.0–1.2). Conclusions In patients with refractory cardiogenic shock supported with VA‐ECMO, sicker patients had higher support since early phases, presenting thereafter higher rates of ventilator‐associated pneumonia but similar survival compared with patients with lower flows.

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“…Direct LV venting could be accomplished by means of a cannula surgically placed into the LV and connected to the venous line of the ECMO circuit or through the deployment of the impella (abiomed, danvers, and MA), a percutaneous transaortic ventricular assist device that provides an antegrade micro-axial flow. The ECPELLA strategy (ECMO + Impella) has emerged as an attractive solution since it combines the positive effect of high-flow arterial support with an efficient LV unloading [18]. A certain level of expertise and technical skills are the main limitation of direct LV venting strategies, that are generally offered in facilities specialized in ECMO support.…”

Section: Ecmo As Btt Managementmentioning

confidence: 99%

“…Other conditions that were reported to be risk factors for death are infection, high levels of lactate, and liver dysfunction [5,[6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

Section: Outcomes Of Btt With Ecmomentioning

confidence: 99%

ECMO as Bridge to Heart Transplantation

Lechiancole¹,

Maiani²,

Vendramin³

et al. 2023

Extracorporeal Membrane Oxygenation Support Therapy

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Extracorporeal membrane oxygenation (ECMO) is increasingly employed to support patients affected by refractory cardiogenic shock. When patients cannot be weaned from ECMO because of severe heart dysfunction, heart transplantation (HTx) or implantation of a durable mechanical circulatory support should be considered. Traditionally, the use of ECMO as a direct bridge to HTx was burdened by high mortality. However, during these last years, the widespread employment of ECMO increased centers’ experience in the management of this device, and new allocation policies provided the highest priority level for ECMO HTx candidates. Therefore, these factors could have mitigated the negative outcomes previously reported. The aim of this chapter is to describe the role of ECMO as a direct bridge to HTx, analyzing results of this strategy, and how to determine candidacy and risk stratification among the severely ill population of patients supported by this mechanical circulatory support.

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ECPella: Concept, Physiology and Clinical Applications

Cited by 36 publications

References 59 publications

Impella support as a bridge to heart surgery in patients with cardiogenic shock

Impella support as a bridge to heart surgery in patients with cardiogenic shock

Time course, factors related to, and prognostic impact of venoarterial extracorporeal membrane flow in cardiogenic shock

ECMO as Bridge to Heart Transplantation

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