IMPELLA® or Extracorporeal Membrane Oxygenation for Left Ventricular Dominant Refractory Cardiogenic Shock

Guillaume Schurtz (1) , Natacha Rousse (1, 2) , Ouriel Saura (1) , Vincent Balmette (1) , Flavien Vincent (1) , Nicolas Lamblin (1, 3) , Sina Porouchani (1) , Basile Verdier (1) , Etienne Puymirat (4) , Emmanuel Robin (1, 2) , Eric van Belle (1, 2) , André Vincentelli (1, 2) , Nadia Aissaoui (4, 5) , Cédric Delhaye (1) , Clément Delmas (6) , Alessandro Cosenza (1) , Laurent Bonello (7, 8) , Francis Juthier (1, 2) , Mouhamed Djahoum Moussa (1, 2) , Gilles Lemesle (1, 2, 3)

1 Institut Coeur Poumon [CHU Lille]
2 RNMCD - Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires - U1011
3 FACT - Alliance française pour les essais cliniques cardio-vasculaires - French Alliance for Cardiovascular Trials
4 HEGP - Hôpital Européen Georges Pompidou [APHP]
5 UPD5 - Université Paris Descartes - Paris 5
6 I2MC - Institut des Maladies Métaboliques et Cardiovasculaires
7 MARS cardio - Mediterranean Association for Research and Studies in Cardiology
8 C2VN - Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research

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® 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® 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®. The primary endpoint was 30-day all-cause death. VA-ECMO patients were younger (52 vs. 59.4, p = 0.006) and had a higher lactate level at baseline than those in the IMPELLA® group (6.84 vs. 3.03 mmol/L, p < 0.001). Duration of MCS was similar between groups (9.4 days vs. 6 days in the VA-ECMO and IMPELLA® groups respectively, p = 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® groups, respectively (p = 0.152). After adjustment, VA-ECMO was associated with a significant reduction in 30-day mortality (HR = 0.25, p = 0.004). A higher rate of MCS escalation was observed in the IMPELLA® group: 32.3% vs. 10.3% (p = 0.003). In patients eligible to either VA-ECMO or IMPELLA® for LV dominant refractory CS, VA-ECMO was associated with improved survival rate and a lower need for escalation.

Mots clés: IMPELLA(®); extracorporeal membrane oxygenation; mechanical circulatory support; cardiogenic shock

Domaines: Médecine humaine et pathologie

Guillaume Schurtz, Natacha Rousse, Ouriel Saura, Vincent Balmette, Flavien Vincent, et al.. IMPELLA® or Extracorporeal Membrane Oxygenation for Left Ventricular Dominant Refractory Cardiogenic Shock. Journal of Clinical Medicine, 2021, 10 (4), pp.759. ⟨10.3390/jcm10040759⟩. ⟨hal-03329186⟩