Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation

Schrage, Benedikt; Becher, Peter Moritz; Bernhardt, A.; Bezerra, Hiram G.; Blankenberg, Stefan; Brunner, Stefan; Colson, P; Deseda, Gaston Cudemus; Dabboura, Salim; Eckner, Dennis; Eden, Matthias; Eitel, Ingo; Frank, Derk; Frey, Norbert; Funamoto, Masaki; Goßling, Alina; Graf, Tobias; Hagl, Christian; Kirchhof, Paulus; Kupka, Danny; Landmesser, Ulf; Lipinski, Jerry; Lopes, Mathew S.; Majunke, Nicolas; Maniuc, Octavian; McGrath, Daniel; Möbius‐Winkler, Sven; Morrow, David A.; Mourad, Marc; Noel, Curt; Nordbeck, Peter; Orban, Martin; Pappalardo, Federico; Patel, Sandeep M.; Pauschinger, Matthias; Pazzanese, Vittorio; Reichenspurner, Hermann; Sandri, Monica; Schulze, P. Christian; Schwinger, Robert H. G.; Sinning, Jan Malte; Aksoy, Adem; Skurk, Carsten; Szczanowicz, Lukasz; Thiele, Holger; Tietz, Franziska; Varshney, Anubodh; Wechsler, Lukas; Westermann, Dirk

doi:10.1161/circulationaha.120.048792

Cited by 291 publications

(229 citation statements)

References 30 publications

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“…Additionally, the comparison is limited to Impella 5.0 and does not consider the use of other temporary MCS devices, nor the utilization of VA-ECMO and Impella 5.0 in the same patient, which has been documented in clinical practice. 29 , 32 Potential differences between settings such as placement in a catheter laboratory versus operating room (e.g. in terms of medical resource use) were also not considered in the analysis; however, this would not have influenced the results of the analysis when considered from the payer (health insurance) perspective.…”

Section: Discussionmentioning

confidence: 99%

Budget Impact Associated with the Introduction of the Impella 5.0® Mechanical Circulatory Support Device for Cardiogenic Shock in France

Guyader¹,

Pernot²,

Delmas³

et al. 2021

CEOR

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Aim: Cardiogenic shock (CS), if not diagnosed and treated rapidly, can lead to irreversible multiorgan damage and death. An economic analysis was conducted to determine the budget impact of the introduction of Impella 5.0 ® , a mechanical circulatory support (MCS) device that directly unloads the left ventricle, into clinical practice in patients with left ventricular CS in France. Methods: A budget impact model was developed to compare the cost of Impella 5.0 with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) from the perspective of the French national healthcare insurer. Costs associated with Impella 5.0, plus complicationrelated costs for VA-ECMO or Impella 5.0 from 2019 were included and clinical input data relating to complication rates and time spent on device were sourced from published literature. Extensive scenario and one-way deterministic sensitivity analyses were performed to explore the influence of uncertainty around key input parameters. Results: Over a time horizon of 5 years, the introduction of Impella 5.0 was associated with cumulative savings of EUR 4.3 million. The results were driven by the lower risk of devicerelated complications associated with Impella 5.0. Savings were apparent from Year 1 onwards, with savings in excess of EUR 375,000 projected in Year 1 alone. On a perpatient level, in Year 1, estimated savings with the introduction of Impella 5.0 totaled EUR 616 per patient. Sensitivity analyses showed that the findings of the analysis were robust. Conclusion:The Impella 5.0 device was associated with cumulative cost savings in excess of EUR 4 million over a 5-year period compared with current practice. Projected savings were driven by a lower rate of device-related complications with Impella 5.0 compared with VA-ECMO.

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Section: Discussionmentioning

confidence: 99%

Budget Impact Associated with the Introduction of the Impella 5.0® Mechanical Circulatory Support Device for Cardiogenic Shock in France

Guyader¹,

Pernot²,

Delmas³

et al. 2021

CEOR

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“…This strategy may cause left ventricle (LV) distension which compromises myocardial recovery 5 . Direct LV unloading provided by Impella was associated with lower mortality in patients with cardiogenic shock supported with V-A-ECMO in a recent international multicenter study 6 .…”

Section: Introductionmentioning

confidence: 93%

“…The Impella is a catheter-mounted microaxial flow pump capable of drawing from 2.5 to 6.0 to l/min of blood from the left ventricle into the aortic root, across the aortic valve. The current use of Impella and V-A ECMO is called ECPella and it is an efficient technique to unload the LV 6 .…”

Section: Ecpellamentioning

confidence: 99%

“…Noteworthy, recent literature suggest improved outcome when adjunct unloading strategies are deployed 6 . In a routine clinical practice, patients under high-flow V-A ECMO support (>4 l/min) and exhibiting a dilated LV in the virtual absence of native left ventricular contractility, should be considered at a very high risk for significant LV overload.…”

Section: Clinical Remarkmentioning

confidence: 99%

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ECPella: Concept, Physiology and Clinical Applications

Meani

Lorusso

Pappalardo

2022

Journal of Cardiothoracic and Vascular Anesthesia

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…Und nach 6 Monaten waren von diesen ECMO-Patienten – bei guter Lebensqualität – noch alle am Leben, wohingegen keiner der ACLS-Patienten diesen Zeitpunkt erlebte. In einer weiteren Kohortenstudie von 686 Patienten zum Einsatz der VA-ECMO beim kardiogenen Schock zeigte sich, dass die pathophysiologisch sinnvoll erscheinende zusätzliche Entlastung des linken Ventrikels durch ein Impella-System (Abiomed, Danvers, MA, USA) die Mortalität weiter senkt [ 14 ].…”

Section: Interventionelle Therapieunclassified

Neue Therapiekonzepte für die Herzinsuffizienz

2021

Self Cite

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Die Versorgung von Patienten mit Herzinsuffizienz ist in Pandemiezeiten eine besondere Herausforderung, da die Vulnerabilität kardiovaskulär erkrankter Patienten für die COVID-19-Infektion zu einer weiteren Erhöhung der Herzinsuffizienzmorbidität und -mortalität führen könnte. Gleichzeitig weisen viele 2020 publizierte Studien auf günstige Effekte innovativer Therapieprinzipien hin. Bei der Therapie der systolischen Herzinsuffizienz (HFrEF [heart failure with reduced ejection fraction]) rücken SGLT2(„sodium dependent glucose cotransporter 2“)-Inhibitoren und Sacubitril/Valsartan in die erste Reihe.

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Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation

Cited by 291 publications

References 30 publications

Budget Impact Associated with the Introduction of the Impella 5.0® Mechanical Circulatory Support Device for Cardiogenic Shock in France

Budget Impact Associated with the Introduction of the Impella 5.0® Mechanical Circulatory Support Device for Cardiogenic Shock in France

ECPella: Concept, Physiology and Clinical Applications

Neue Therapiekonzepte für die Herzinsuffizienz

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