IMPELLA<sup>®</sup> or Extracorporeal Membrane Oxygenation for Left Ventricular Dominant Refractory Cardiogenic Shock
Mechanical circulatory support (MCS) devices are effective tools in managing refractory cardiogenic shock (CS). Data comparing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and IMPELLA<sup>®</sup> are however scarce. We aimed to assess outcomes of patients implanted with th...
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| Format: | Article |
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MDPI AG
2021-02-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/4/759 |
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| author | Guillaume Schurtz Natacha Rousse Ouriel Saura Vincent Balmette Flavien Vincent Nicolas Lamblin Sina Porouchani Basile Verdier Etienne Puymirat Emmanuel Robin Eric Van Belle André Vincentelli Nadia Aissaoui Cédric Delhaye Clément Delmas Alessandro Cosenza Laurent Bonello Francis Juthier Mouhamed Djahoum Moussa Gilles Lemesle |
| author_facet | Guillaume Schurtz Natacha Rousse Ouriel Saura Vincent Balmette Flavien Vincent Nicolas Lamblin Sina Porouchani Basile Verdier Etienne Puymirat Emmanuel Robin Eric Van Belle André Vincentelli Nadia Aissaoui Cédric Delhaye Clément Delmas Alessandro Cosenza Laurent Bonello Francis Juthier Mouhamed Djahoum Moussa Gilles Lemesle |
| author_sort | Guillaume Schurtz |
| collection | DOAJ |
| description | Mechanical circulatory support (MCS) devices are effective tools in managing refractory cardiogenic shock (CS). Data comparing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and IMPELLA<sup>®</sup> are however scarce. We aimed to assess outcomes of patients implanted with these two devices and eligible to both systems. From 2004 to 2020, we retrospectively analyzed 128 patients who underwent VA-ECMO or IMPELLA<sup>®</sup> in our institution for refractory left ventricle (LV) dominant CS. All patients were eligible to both systems: 97 patients were first implanted with VA-ECMO and 31 with IMPELLA<sup>®</sup>. The primary endpoint was 30-day all-cause death. VA-ECMO patients were younger (52 vs. 59.4, <i>p</i> = 0.006) and had a higher lactate level at baseline than those in the IMPELLA<sup>®</sup> group (6.84 vs. 3.03 mmol/L, <i>p</i> < 0.001). Duration of MCS was similar between groups (9.4 days vs. 6 days in the VA-ECMO and IMPELLA<sup>®</sup> groups respectively, <i>p</i> = 0.077). In unadjusted analysis, no significant difference was observed between groups in 30-day mortality: 43.3% vs. 58.1% in the VA-ECMO and IMPELLA<sup>®</sup> groups, respectively (<i>p</i> = 0.152). After adjustment, VA-ECMO was associated with a significant reduction in 30-day mortality (HR = 0.25, <i>p</i> = 0.004). A higher rate of MCS escalation was observed in the IMPELLA<sup>®</sup> group: 32.3% vs. 10.3% (<i>p</i> = 0.003). In patients eligible to either VA-ECMO or IMPELLA<sup>®</sup> for LV dominant refractory CS, VA-ECMO was associated with improved survival rate and a lower need for escalation. |
| first_indexed | 2024-03-09T00:53:36Z |
| format | Article |
| id | doaj.art-73cacf55e6a4479db370a996a83e39cd |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T00:53:36Z |
| publishDate | 2021-02-01 |
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| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-73cacf55e6a4479db370a996a83e39cd2023-12-11T17:02:12ZengMDPI AGJournal of Clinical Medicine2077-03832021-02-0110475910.3390/jcm10040759IMPELLA<sup>®</sup> or Extracorporeal Membrane Oxygenation for Left Ventricular Dominant Refractory Cardiogenic ShockGuillaume Schurtz0Natacha Rousse1Ouriel Saura2Vincent Balmette3Flavien Vincent4Nicolas Lamblin5Sina Porouchani6Basile Verdier7Etienne Puymirat8Emmanuel Robin9Eric Van Belle10André Vincentelli11Nadia Aissaoui12Cédric Delhaye13Clément Delmas14Alessandro Cosenza15Laurent Bonello16Francis Juthier17Mouhamed Djahoum Moussa18Gilles Lemesle19Cardiac Intensive Care Unit, Heart and Lung Institute, CHU Lille, 59000 Lille, FranceDepartment of Cardiac Surgery, Institut Cœur Poumon, CHU Lille, INSERM U1011, Institut Pasteur de Lille, Université de Lille, 59000 Lille, FranceCardiac Intensive Care Unit, Heart and Lung Institute, CHU Lille, 59000 Lille, FranceCardiac Intensive Care Unit, Heart and Lung Institute, CHU Lille, 59000 Lille, FranceDepartment of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, CHU Lille, Institut Coeur Poumon, Cardiology, 59000 Lille, FranceCardiac Intensive Care Unit, Heart and Lung Institute, CHU Lille, 59000 Lille, FranceDepartment of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, CHU Lille, Institut Coeur Poumon, Cardiology, 59000 Lille, FranceCardiac Intensive Care Unit, Heart and Lung Institute, CHU Lille, 59000 Lille, FranceDepartment of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, 75015 Paris, FranceDepartment of Cardiac Surgery, Institut Cœur Poumon, CHU Lille, INSERM U1011, Institut Pasteur de Lille, Université de Lille, 59000 Lille, FranceDepartment of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, CHU Lille, Institut Coeur Poumon, Cardiology, 59000 Lille, FranceDepartment of Cardiac Surgery, Institut Cœur Poumon, CHU Lille, INSERM U1011, Institut Pasteur de Lille, Université de Lille, 59000 Lille, FranceDepartment of Critical Care Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), Université Paris-Descartes, 75015 Paris, FranceDepartment of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, CHU Lille, Institut Coeur Poumon, Cardiology, 59000 Lille, FranceINSERM UMR-1048, Intensive Cardiac Care Unit, Rangueil University Hospital, 31400 Toulouse, FranceDepartment of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, CHU Lille, Institut Coeur Poumon, Cardiology, 59000 Lille, FranceCardiology Department, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, FranceDepartment of Cardiac Surgery, Institut Cœur Poumon, CHU Lille, INSERM U1011, Institut Pasteur de Lille, Université de Lille, 59000 Lille, FranceDepartment of Cardiac Surgery, Institut Cœur Poumon, CHU Lille, INSERM U1011, Institut Pasteur de Lille, Université de Lille, 59000 Lille, FranceCardiac Intensive Care Unit, Heart and Lung Institute, CHU Lille, 59000 Lille, FranceMechanical circulatory support (MCS) devices are effective tools in managing refractory cardiogenic shock (CS). Data comparing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and IMPELLA<sup>®</sup> are however scarce. We aimed to assess outcomes of patients implanted with these two devices and eligible to both systems. From 2004 to 2020, we retrospectively analyzed 128 patients who underwent VA-ECMO or IMPELLA<sup>®</sup> in our institution for refractory left ventricle (LV) dominant CS. All patients were eligible to both systems: 97 patients were first implanted with VA-ECMO and 31 with IMPELLA<sup>®</sup>. The primary endpoint was 30-day all-cause death. VA-ECMO patients were younger (52 vs. 59.4, <i>p</i> = 0.006) and had a higher lactate level at baseline than those in the IMPELLA<sup>®</sup> group (6.84 vs. 3.03 mmol/L, <i>p</i> < 0.001). Duration of MCS was similar between groups (9.4 days vs. 6 days in the VA-ECMO and IMPELLA<sup>®</sup> groups respectively, <i>p</i> = 0.077). In unadjusted analysis, no significant difference was observed between groups in 30-day mortality: 43.3% vs. 58.1% in the VA-ECMO and IMPELLA<sup>®</sup> groups, respectively (<i>p</i> = 0.152). After adjustment, VA-ECMO was associated with a significant reduction in 30-day mortality (HR = 0.25, <i>p</i> = 0.004). A higher rate of MCS escalation was observed in the IMPELLA<sup>®</sup> group: 32.3% vs. 10.3% (<i>p</i> = 0.003). In patients eligible to either VA-ECMO or IMPELLA<sup>®</sup> for LV dominant refractory CS, VA-ECMO was associated with improved survival rate and a lower need for escalation.https://www.mdpi.com/2077-0383/10/4/759IMPELLA<sup>®</sup>extracorporeal membrane oxygenationmechanical circulatory supportcardiogenic shock |
| spellingShingle | Guillaume Schurtz Natacha Rousse Ouriel Saura Vincent Balmette Flavien Vincent Nicolas Lamblin Sina Porouchani Basile Verdier Etienne Puymirat Emmanuel Robin Eric Van Belle André Vincentelli Nadia Aissaoui Cédric Delhaye Clément Delmas Alessandro Cosenza Laurent Bonello Francis Juthier Mouhamed Djahoum Moussa Gilles Lemesle IMPELLA<sup>®</sup> or Extracorporeal Membrane Oxygenation for Left Ventricular Dominant Refractory Cardiogenic Shock Journal of Clinical Medicine IMPELLA<sup>®</sup> extracorporeal membrane oxygenation mechanical circulatory support cardiogenic shock |
| title | IMPELLA<sup>®</sup> or Extracorporeal Membrane Oxygenation for Left Ventricular Dominant Refractory Cardiogenic Shock |
| title_full | IMPELLA<sup>®</sup> or Extracorporeal Membrane Oxygenation for Left Ventricular Dominant Refractory Cardiogenic Shock |
| title_fullStr | IMPELLA<sup>®</sup> or Extracorporeal Membrane Oxygenation for Left Ventricular Dominant Refractory Cardiogenic Shock |
| title_full_unstemmed | IMPELLA<sup>®</sup> or Extracorporeal Membrane Oxygenation for Left Ventricular Dominant Refractory Cardiogenic Shock |
| title_short | IMPELLA<sup>®</sup> or Extracorporeal Membrane Oxygenation for Left Ventricular Dominant Refractory Cardiogenic Shock |
| title_sort | impella sup r sup or extracorporeal membrane oxygenation for left ventricular dominant refractory cardiogenic shock |
| topic | IMPELLA<sup>®</sup> extracorporeal membrane oxygenation mechanical circulatory support cardiogenic shock |
| url | https://www.mdpi.com/2077-0383/10/4/759 |
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