PMID- 27709750
OWN - NLM
STAT- MEDLINE
DCOM- 20171109
LR  - 20220408
IS  - 1879-0844 (Electronic)
IS  - 1388-9842 (Linking)
VI  - 19
IP  - 3
DP  - 2017 Mar
TI  - Concomitant implantation of Impella((R)) on top of veno-arterial extracorporeal 
      membrane oxygenation may improve survival of patients with cardiogenic shock.
PG  - 404-412
LID - 10.1002/ejhf.668 [doi]
AB  - AIMS: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support 
      stabilizes patients with cardiogenic shock. Despite improved oxygenation and 
      peripheral circulation, LV unloading may be impeded due to the increased 
      afterload, resulting in a failing static left ventricle and in high mortality. 
      METHODS AND RESULTS: We describe for the first time a large series of patients 
      treated with the combination of VA-ECMO and Impella((R)) compared with patients 
      with VA-ECMO only. We retrospectively collected data on patients from two 
      tertiary critical care referral centres. We enrolled 157 patients treated with 
      VA-ECMO from January 2013 to April 2015: 123 received VA-ECMO support and 34 had 
      concomitant treatment with VA-ECMO and Impella. A propensity-matching analysis 
      was performed in a 2:1 ratio, resulting in 42 patients undergoing VA-ECMO alone 
      (control group) compared with 21 patients treated with VA-ECMO and Impella. 
      Patients in the VA-ECMO and Impella group had a significantly lower hospital 
      mortality (47% vs. 80%, P < 0.001) and a higher rate of successful bridging to 
      either recovery or further therapy (68% vs. 28%, P < 0.001) compared with VA-ECMO 
      patients. A higher need for continuous veno-venous haemofiltration (48% vs. 19%, 
      P = 0.02) and increased haemolysis (76% vs. 33%, P = 0.004) were reported in the 
      study group due to higher survival. There was no difference in major bleeding 
      rates between the two groups (VA-ECMO and Impella 38% vs. VA-ECMO 29%, P = 0.6). 
      CONCLUSIONS: Concomitant treatment with VA-ECMO and Impella may improve outcome 
      in patients with cardiogenic shock compared with VA-ECMO only. Nevertheless, 
      randomized studies are needed to validate these promising results further.
CI  - (c) 2016 The Authors. European Journal of Heart Failure (c) 2016 European Society of 
      Cardiology.
FAU - Pappalardo, Federico
AU  - Pappalardo F
AD  - Department of Cardiothoracic Anaesthesia and Intensive Care, IRCCS San Raffaele 
      Scientific Institute, Vita Salute University, Milan, Italy.
FAU - Schulte, Christian
AU  - Schulte C
AD  - Department of General and Interventional Cardiology, University Heart Centre 
      Hamburg Eppendorf, Hamburg, Germany.
FAU - Pieri, Marina
AU  - Pieri M
AD  - Department of Cardiothoracic Anaesthesia and Intensive Care, IRCCS San Raffaele 
      Scientific Institute, Vita Salute University, Milan, Italy.
FAU - Schrage, Benedikt
AU  - Schrage B
AD  - Department of General and Interventional Cardiology, University Heart Centre 
      Hamburg Eppendorf, Hamburg, Germany.
FAU - Contri, Rachele
AU  - Contri R
AD  - Department of Interventional Cardiology, IRCCS San Raffaele Scientific Institute, 
      Vita Salute University, Milan, Italy.
FAU - Soeffker, Gerold
AU  - Soeffker G
AD  - Department of Intensive Care, Centre for Anaesthesiology and Intensive Care 
      Medicine, University Medical Centre Hamburg Eppendorf, Hamburg, Germany.
FAU - Greco, Teresa
AU  - Greco T
AD  - Department of Cardiothoracic Anaesthesia and Intensive Care, IRCCS San Raffaele 
      Scientific Institute, Vita Salute University, Milan, Italy.
FAU - Lembo, Rosalba
AU  - Lembo R
AD  - Department of Cardiothoracic Anaesthesia and Intensive Care, IRCCS San Raffaele 
      Scientific Institute, Vita Salute University, Milan, Italy.
FAU - Mullerleile, Kai
AU  - Mullerleile K
AD  - Department of General and Interventional Cardiology, University Heart Centre 
      Hamburg Eppendorf, Hamburg, Germany.
FAU - Colombo, Antonio
AU  - Colombo A
AD  - Department of Interventional Cardiology, IRCCS San Raffaele Scientific Institute, 
      Vita Salute University, Milan, Italy.
FAU - Sydow, Karsten
AU  - Sydow K
AD  - Department of General and Interventional Cardiology, University Heart Centre 
      Hamburg Eppendorf, Hamburg, Germany.
FAU - De Bonis, Michele
AU  - De Bonis M
AD  - Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Vita 
      Salute University, Milan, Italy.
FAU - Wagner, Florian
AU  - Wagner F
AD  - Department of Cardiovascular Surgery, University Heart Centre Hamburg Eppendorf, 
      Hamburg, Germany.
FAU - Reichenspurner, Hermann
AU  - Reichenspurner H
AD  - Department of Cardiovascular Surgery, University Heart Centre Hamburg Eppendorf, 
      Hamburg, Germany.
FAU - Blankenberg, Stefan
AU  - Blankenberg S
AD  - Department of General and Interventional Cardiology, University Heart Centre 
      Hamburg Eppendorf, Hamburg, Germany.
AD  - German Centre for Cardiovascular Research (DZHK), Partner site 
      Hamburg/Lubeck/Kiel, Hamburg, Gemany.
FAU - Zangrillo, Alberto
AU  - Zangrillo A
AD  - Department of Cardiothoracic Anaesthesia and Intensive Care, IRCCS San Raffaele 
      Scientific Institute, Vita Salute University, Milan, Italy.
FAU - Westermann, Dirk
AU  - Westermann D
AD  - Department of General and Interventional Cardiology, University Heart Centre 
      Hamburg Eppendorf, Hamburg, Germany.
AD  - German Centre for Cardiovascular Research (DZHK), Partner site 
      Hamburg/Lubeck/Kiel, Hamburg, Gemany.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20161006
PL  - England
TA  - Eur J Heart Fail
JT  - European journal of heart failure
JID - 100887595
SB  - IM
CIN - Eur J Heart Fail. 2017 Mar;19(3):413-415. PMID: 27976479
CIN - Eur J Heart Fail. 2018 Mar;20(3):622-623. PMID: 28948707
CIN - Eur J Heart Fail. 2018 Mar;20(3):621-622. PMID: 28949061
MH  - Aged
MH  - Case-Control Studies
MH  - Combined Modality Therapy
MH  - *Extracorporeal Membrane Oxygenation
MH  - Female
MH  - Heart Failure/*therapy
MH  - *Heart-Assist Devices
MH  - *Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Propensity Score
MH  - Prosthesis Implantation
MH  - Retrospective Studies
MH  - Shock, Cardiogenic/*therapy
MH  - Survival Rate
MH  - Ventricular Dysfunction, Left/*therapy
OTO - NOTNLM
OT  - Extracorporeal circulation
OT  - Heart failure
OT  - Heart-assist device
OT  - Percutaneous left ventricular assist device
OT  - Shock
EDAT- 2016/10/07 06:00
MHDA- 2017/11/10 06:00
CRDT- 2016/10/07 06:00
PHST- 2016/03/19 00:00 [received]
PHST- 2016/09/01 00:00 [revised]
PHST- 2016/09/02 00:00 [accepted]
PHST- 2016/10/07 06:00 [pubmed]
PHST- 2017/11/10 06:00 [medline]
PHST- 2016/10/07 06:00 [entrez]
AID - 10.1002/ejhf.668 [doi]
PST - ppublish
SO  - Eur J Heart Fail. 2017 Mar;19(3):404-412. doi: 10.1002/ejhf.668. Epub 2016 Oct 6.