Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used for the treatment of cardiogenic shock. However, VA-ECMO might affect myocardial recovery, which could damage the myocardium and negatively affect survival. The Impella unloads the left ventricle. This study aimed to evaluate whether left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO was associated with lower mortality.
Medical data from 686 patients treated with VA-ECMO, suffering with cardiogenic shock, with or without left ventricular unloading using an Impella were collected. Left ventricular unloading was used in 49% of the patients . In the matched cohort, left ventricular unloading was associated with lower 30-day mortality without any differences in various subgroups.
Complications arose more often in patients with left ventricular unloading:
- severe bleeding in 98 (38.4%) vs. 45 (17.9%);
- access site-related ischemia in 55 (21.6%) vs. 31 (12.3%);
- abdominal compartment in 23 (9.4%) vs. 9 (3.7%);
- and renal replacement therapy in 148 (58.5%) vs. 99 (39.1%).
In conclusion, left ventricular unloading was associated with lower mortality in patients for cardiogenic shock with VA-ECMO, despite the greater complication rates. The findings of this multicenter, international cohort study support the use of left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO and call for further validation, ideally in a randomized, controlled trial.
Ref: https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.120.048792
