Impella 5.0 therapy as a bridge-to-decision option for patients on extracorporeal life support with unclear neurological outcomes

Abstract OBJECTIVES Peripheral venoarterial extracorporeal life support (ECLS) for the treatment of cardiogenic shock has shown to improve survival but is associated with complications. However, if the patient cannot be weaned from ECLS, their therapy options are limited. Although durable left ventr...

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Published in:European journal of cardio-thoracic surgery 2019-12, Vol.56 (6), p.1031-1036
Main Authors: Bernhardt, Alexander M, Zipfel, Svante, Reiter, Beate, Hakmi, Samer, Castro, Liesa, Söffker, Gerold, Kluge, Stefan, Lubos, Edith, Rybczinski, Meike, Grahn, Hanno, Schrage, Benedikt, Becher, Peter Moritz, Barten, Markus J, Westermann, Dirk, Blankenberg, Stefan, Reichenspurner, Hermann
Format: Article
Language:English
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Summary:Abstract OBJECTIVES Peripheral venoarterial extracorporeal life support (ECLS) for the treatment of cardiogenic shock has shown to improve survival but is associated with complications. However, if the patient cannot be weaned from ECLS, their therapy options are limited. Although durable left ventricular assist device implantation might be an option in such cases, an unclear neurological outcome is often a contraindication. We hypothesize that Impella 5.0 therapy provides sufficient circulatory support while avoiding ECLS-related complications, thereby allowing for an adequate evaluation of a patient’s neurological state and facilitating further treatment options. METHODS We retrospectively reviewed data from 22 ECLS patients (mean age 56.5 ± 10.7 years) with an unclear neurological status who underwent Impella 5.0 implantation between January 2016 and July 2018 in our institution. Neurological status was evaluated on a daily basis using the cerebral performance category score and the modified Rankin scale. RESULTS Sixteen patients (72.7%) were resuscitated before ECLS implantation and 13 patients (59.1%) had acute myocardial infarction. The mean duration on ECLS before Impella 5.0 implantation was 9.3 ± 1.7 days. All patients were successfully weaned from ECLS by Impella 5.0 implantation via the axillary artery. The mean duration on Impella 5.0 was 16.3 ± 4.7 days. In surviving patients, both quantitative measurements of cerebral performance improved after 30 days compared to the baseline (P 
ISSN:1010-7940
1873-734X
DOI:10.1093/ejcts/ezz118