Impact of Left Ventricular Decompression with Impella During Venoarterial Extracorporeal Membrane Oxygenation Support in Acute Myocardial Infarction complicated by Cardiogenic Shock

Singh, Anmol

Impact of Left Ventricular Decompression with Impella During Venoarterial Extracorporeal Membrane Oxygenation Support in Acute Myocardial Infarction complicated by Cardiogenic Shock

Monday, May 20, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Anmol Singh, MPH , Hofstra Northwell School of Medicine - North Shore University Hospital, Manhasset, NY

Andrew Scatola, MD , Hofstra Northwell School of Medicine - North Shore University Hospital, Manhasset, NY

Karanbir Singh , New York Institute of Technology, Old Westbury, NY

Salam Jalili , New York Institute of Technology, Old Westbury, NY

Sean Bae , Meharry Medical College, Nashville, TN

AmitKumar Patel, MD, MPH , Hofstra Northwell School of Medicine - North Shore University Hospital, Manhasset, NY

Krunalkumar Patel, M.D. , Hofstra Northwell School of Medicine - North Shore University Hospital, Philadelphia, PA

Tasveer Khawaja , Hofstra Northwell School of Medicine - North Shore University Hospital, Manhasset, NY

Perwaiz M. Meraj, M.D., FSCAI , Hofstra North Shore-LIJ School of Medicine, Oyster Bay Cove, NY

Background:
Use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in acute myocardial infarction complicated by refractory cardiogenic shock (AMI-CS) allows for complete circulatory support at the expense of increased left ventricular afterload. Limited data suggest the combination of VA-ECMO and Impella (ECPELLA) may lead to improved 30-day survival.

Methods:
This was a prospective observational study for all patients (2015-9/2018) with AMI-CS requiring either VA-ECMO or ECPELLA. Demographics, echocardiographic parameters, indication for support, and hemodynamic data were collected for all patients. The primary outcome was all-cause mortality at 30 days. Secondary outcomes included survival to explant of support, survival to discharge, as well as safety end-points, including hematoma, bleeding, and anemia.

Results:
A total of 34 patients were identified; 15 had ECPELLA and 19 had VA-ECMO. Both groups had similar baseline characteristics. Survival to device explant was 80% in ECPELLA group and 53% in VA-ECMO group (p: 0.11). Survival to discharge and 30 days showed no significant difference. There were no differences in safety endpoints.

Conclusions:
We found a trend to improved mortality in the ECPELLA group as compared to VA-ECMO. We hypothesize that these results may become significant with larger sample sizes. Ideally, a large, randomized, prospective trial is necessary to better delineate the benefits vs. risks of ECPELLA vs. VA-ECMO, however this is unlikely to occur.