High flow from Impella 5.5 with partial veno-arterial extracorporeal membrane oxygenation support: Case series

Artif Organs. 2022 Jun;46(6):1198-1203. doi: 10.1111/aor.14183. Epub 2022 Feb 2.

Abstract

Optimal flow balance between Impella 5.5 and veno-arterial extracorporeal membrane oxygenation (ECMO) support in the setting of EC-PELLA (ECMO+Impella) is unknown. Outcomes of high Impella 5.5 flow in the setting of EC-PELLA support were reviewed (N = 7). EC-PELLA was successfully explanted in 6 patients (bridge-to-transplant, N = 1; bridge-to-recovery, N = 5). The median duration of EC-PELLA support in explanted patients was 6 days. Survival at discharge was 71.4% (5 patients). In terms of device-related events, either VA-ECMO or Impella-related complications were not experienced. The median performance level of Impella 5.5 was P5 at the time of starting EC-PELLA support and then increased with time up to the median of P8 with increment of the Impella flow, and index (L/min/m2 ). The percentage of Impella flow per total EC- PELLA flow reached 50% after 48 h of support. The vasoactive-inotropic score and serum lactate level improved after institution of EC-PELLA support as well as the pulmonary artery pressures and central venous pressure. In conclusion, a high pump flow from Impella 5.5 with partial VA-ECMO support in the setting of EC-PELLA provided great support with favorable survival and device-related complications rate.

Keywords: EC-PELLA; Impella; cardiogenic shock; extracorporeal membrane oxygenation.

Publication types

  • Case Reports

MeSH terms

  • Extracorporeal Membrane Oxygenation* / adverse effects
  • Heart-Assist Devices* / adverse effects
  • Humans
  • Research
  • Retrospective Studies
  • Shock, Cardiogenic / etiology
  • Shock, Cardiogenic / surgery