PMID- 32061461
OWN - NLM
STAT- MEDLINE
DCOM- 20210429
LR  - 20210429
IS  - 1557-8615 (Electronic)
IS  - 0883-9441 (Linking)
VI  - 57
DP  - 2020 Jun
TI  - Bridging INTERMACS 1 patients from VA-ECMO to LVAD via Impella 5.0: De-escalate 
      and ambulate.
PG  - 259-263
LID - S0883-9441(19)31374-7 [pii]
LID - 10.1016/j.jcrc.2019.12.028 [doi]
AB  - PURPOSE: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) stabilizes 
      patients in refractory cardiogenic shock. However, ECMO-related complications 
      strongly affect the outcome, especially if a long-term LVAD is needed. METHODS 
      AND MATERIALS: We describe a new strategy in management of INTERMACS 1 patients 
      consisting in early weaning from VA-ECMO with axillary Impella 5.0 as a bridge to 
      LVAD implantation. Nine patients in two European centres are described. RESULTS: 
      All patients were implanted with VA-ECMO for initial hemodynamic and metabolic 
      stabilization. After a median time of 8 days, Impella 5.0 was implanted. Impella 
      support allowed in all patients weaning from inotropes and from VA-ECMO (after a 
      median time of 22 h). No patients had right ventricular failure after 
      ECMO-weaning and most patients were mobilized and orally fed (88.9%) during 
      Impella support. All patient underwent LVAD implantation after a median Impella 
      time of 17 days. Only one patient had right-ventricular failure after LVAD 
      implantation. All patients were discharged from hospital after a median time of 
      40 days. CONCLUSION: Early weaning from VA-ECMO with Impella 5.0 as a bridge to 
      LVAD is a safe and effective strategy in management of INTERMACS 1 patients. This 
      approach minimizes ECMO-related complications and allows patient mobilization and 
      right ventricular function optimization before LVAD implantation.
CI  - Copyright (c) 2019. Published by Elsevier Inc.
FAU - Bertoldi, Letizia F
AU  - Bertoldi LF
AD  - IRCCS San Raffaele Scientific Institute, Milan, Italy.
FAU - Pappalardo, Federico
AU  - Pappalardo F
AD  - IRCCS San Raffaele Scientific Institute, Milan, Italy.
FAU - Lubos, Edith
AU  - Lubos E
AD  - University Heart and Vascular Center Hamburg, Germany.
FAU - Grahn, Hanno
AU  - Grahn H
AD  - University Heart and Vascular Center Hamburg, Germany.
FAU - Rybczinski, Meike
AU  - Rybczinski M
AD  - University Heart and Vascular Center Hamburg, Germany.
FAU - Barten, Markus J
AU  - Barten MJ
AD  - University Heart and Vascular Center Hamburg, Germany.
FAU - Legros, Tim
AU  - Legros T
AD  - University Heart and Vascular Center Hamburg, Germany.
FAU - Bertoglio, Luca
AU  - Bertoglio L
AD  - IRCCS San Raffaele Scientific Institute, Milan, Italy.
FAU - Schrage, Benedikt
AU  - Schrage B
AD  - University Heart and Vascular Center Hamburg, Germany.
FAU - Westermann, Dirk
AU  - Westermann D
AD  - University Heart and Vascular Center Hamburg, Germany.
FAU - Lapenna, Elisabetta
AU  - Lapenna E
AD  - IRCCS San Raffaele Scientific Institute, Milan, Italy.
FAU - Reichenspurner, Hermann
AU  - Reichenspurner H
AD  - University Heart and Vascular Center Hamburg, Germany.
FAU - Bernhardt, Alexander M
AU  - Bernhardt AM
AD  - University Heart and Vascular Center Hamburg, Germany. Electronic address: 
      Al.Bernhardt@uke.de.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20200110
PL  - United States
TA  - J Crit Care
JT  - Journal of critical care
JID - 8610642
SB  - IM
CIN - J Crit Care. 2020 Dec;60:348. PMID: 32404237
CIN - J Crit Care. 2020 Dec;60:347. PMID: 32732128
MH  - Adult
MH  - Extracorporeal Membrane Oxygenation/*instrumentation/methods
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/*therapy
MH  - *Heart-Assist Devices
MH  - Hemodynamics
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Research Design
MH  - Retrospective Studies
MH  - Shock, Cardiogenic/*therapy
MH  - Ventricular Function, Right
OTO - NOTNLM
OT  - Cardiogenic shock
OT  - Impella 5.0
OT  - Left ventricular assist device
OT  - Veno-arterial extracorporeal membrane oxygenation
EDAT- 2020/02/18 06:00
MHDA- 2021/04/30 06:00
CRDT- 2020/02/17 06:00
PHST- 2019/09/05 00:00 [received]
PHST- 2019/12/25 00:00 [revised]
PHST- 2019/12/31 00:00 [accepted]
PHST- 2020/02/18 06:00 [pubmed]
PHST- 2021/04/30 06:00 [medline]
PHST- 2020/02/17 06:00 [entrez]
AID - S0883-9441(19)31374-7 [pii]
AID - 10.1016/j.jcrc.2019.12.028 [doi]
PST - ppublish
SO  - J Crit Care. 2020 Jun;57:259-263. doi: 10.1016/j.jcrc.2019.12.028. Epub 2020 Jan 
      10.