Open AccessEC-VAD: Combined Use of Extracorporeal Membrane Oxygenation and Percutaneous Microaxial Pump Left Ventricular Assist Device
Author(s) -
O. Akanni,
Koji Takeda,
L.K. Truby,
Paul Kurlansky,
Codruța Chiuzan,
Jiho Han,
V.K. Topkara,
M. Yuzefpolskaya,
P.C. Colombo,
Dimitrios Karmpaliotis,
Jeffery W. Moses,
Yoshifumi Naka,
A.R. Garan,
Ajay J. Kirtane,
Hiroo Takayama
Publication year - 2019
Publication title -
asaio journal
Language(s) - English
Resource type - Journals
eISSN - 1538-943X
pISSN - 1058-2916
DOI - 10.1097/mat.0000000000000804
Subject(s) - medicine , extracorporeal membrane oxygenation , impella , cardiogenic shock , ventricular assist device , percutaneous , cardiology , surgery , heart failure , myocardial infarction
Combination of venoarterial extracorporeal membrane oxygenation (VA-ECMO) and a percutaneous microaxial left ventricular assist device (pLVAD), or "EC-VAD," has been reported in cases of left ventricular decompression with mixed results. We conducted a retrospective review of patients who received EC-VAD (n = 29) or isolated VA-ECMO therapy (ECMO-only; n = 196) for refractory cardiogenic shock between February 2011 and October 2014. Fourteen patients received VA-ECMO and then Impella pLVAD (E→EC-VAD), and 15 received the Impella pump then VA-ECMO (I→EC-VAD). E→EC-VAD patients demonstrated decreased pulmonary artery systolic (36.00 ± 16.84 mm Hg versus 30.63 ± 12.13 mm Hg; p = 0.049) and diastolic (24.25 ± 13.45 mm Hg versus 17.25 ± 7.96 mm Hg, p = 0.049) pressures by 24 hours post-EC-VAD implant. In the same period, I→EC-VAD patients demonstrated improved SvO2 (43.14 ± 16.75% versus 75.18 ± 13.88%, p = 0.043) and PaO2/FiO2 ratio (148.55 ± 67.69 mm Hg versus 374.51 ± 170.97 mm Hg, p = 0.043). Thirty-day survival rates were 42.9% in E→EC-VAD, 46.7% in I→EC-VAD, and 49.0% in ECMO-only (p = 0.913). Hemolysis occurred more in EC-VAD patients (44.83% versus 17.35% in ECMO-only, p = 0.002); however, there was no increased frequency of other adverse events including bleeding and lower limb ischemia. Despite increased hemolysis, combined use of VA-ECMO and pLVAD may improve or circumvent left ventricular distension in refractory cardiogenic shock while promoting adequate blood flow.