Veno-arterial extracorporeal membrane oxygenation with concomitant Impella versus concomitant intra-aortic-balloon-pump for cardiogenic shock.

Autor:	Au SY; Intensive Care Unit, Queen Elizabeth Hospital, Kowloon, Hong Kong., Fong KM; Intensive Care Unit, Queen Elizabeth Hospital, Kowloon, Hong Kong., Tsang CS; Cardiology Services, Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong., Chan KA; Cardiology Services, Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong., Wong CY; Cardiology Services, Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong., Ng WG; Intensive Care Unit, Queen Elizabeth Hospital, Kowloon, Hong Kong., Lee KYM; Cardiology Services, Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong.
Jazyk:	angličtina
Zdroj:	Perfusion [Perfusion] 2023 Jan; Vol. 38 (1), pp. 51-57. Date of Electronic Publication: 2021 Jul 28.
DOI:	10.1177/02676591211033947
Abstrakt:	Introduction: The intra-aortic balloon pump (IABP) and Impella are left ventricular unloading devices with peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) in place and later serve as bridging therapy when VA-ECMO is terminated. We aimed to determine the potential differences in clinical outcomes and rate of complications between the two combinations of mechanical circulatory support. Methods: This was a retrospective, single institutional cohort study conducted in the intensive care unit (ICU) of Queen Elizabeth Hospital, Hong Kong. Inclusion criteria included all patients aged ⩾18 years, who had VA-ECMO support, and who had left ventricular unloading by either IABP or Impella between January 1, 2018 and October 31, 2020. Patients <18 years old, with central VA-ECMO, who did not require left ventricular unloading, or who underwent surgical venting procedures were excluded. The primary outcome was ECMO duration. Secondary outcomes included length of stay (LOS) in the ICU, hospital LOS, mortality, and complication rate. Results: Fifty-two patients with ECMO + IABP and 14 patients with ECMO + Impella were recruited. No statistically significant difference was observed in terms of ECMO duration (2.5 vs 4.6 days, p = 0.147), ICU LOS (7.7 vs 10.8 days, p = 0.367), and hospital LOS (14.8 vs 16.5 days, p = 0.556) between the two groups. No statistically significant difference was observed in the ECMO, ICU, and hospital mortalities between the two groups. Specific complications related to the ECMO and Impella combination were also noted. Conclusions: Impella was not shown to offer a statistically significant clinical benefit compared with IABP in conjunction with ECMO. Clinicians should be aware of the specific complications of using Impella.
Databáze:	MEDLINE
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