1. Bridging INTERMACS 1 patients from VA-ECMO to LVAD via Impella 5.0: De-escalate and ambulate
- Author
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Benedikt Schrage, Hermann Reichenspurner, Letizia Bertoldi, Alexander M. Bernhardt, Meike Rybczinski, Markus J. Barten, Edith Lubos, Elisabetta Lapenna, Federico Pappalardo, Dirk Westermann, Tim Legros, Luca Bertoglio, Hanno Grahn, Bertoldi, L. F., Pappalardo, F., Lubos, E., Grahn, H., Rybczinski, M., Barten, M. J., Legros, T., Bertoglio, L., Schrage, B., Westermann, D., Lapenna, E., Reichenspurner, H., and Bernhardt, A. M.
- Subjects
Inotrope ,medicine.medical_specialty ,medicine.medical_treatment ,Hemodynamics ,Left ventricular assist device ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Extracorporeal membrane oxygenation ,medicine ,Cardiogenic shock ,Impella ,Ventricular function ,Early weaning ,business.industry ,030208 emergency & critical care medicine ,medicine.disease ,Surgery ,surgical procedures, operative ,030228 respiratory system ,Right ventricular failure ,Veno-arterial extracorporeal membrane oxygenation ,Impella 5.0 ,business - Abstract
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.
- Published
- 2020