Kardio 365 - úvodní stránka
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M. Pazderník, M. Gramegna, M. Morosin, A. Azzu, A. Rosenberg, R. Trimlett, S. Davies, S. Ledot, S. Price (Praha, London, United Kingdom)
Tématický okruh: Mechanické podpory oběhu
Typ: Poster - lékařský, 17. konference ČAAK

Introduction: Effective unloading of left ventricle (LV) might mitigate negative side effects of increased afterload in V-A ECMO patients. However, whether the addition of intra-aortic balloon pump (IABP) or Impella to VA-ECMO improves outcomes in patients with refractory cardiogenic shock (CS) is still unclear.

Methods: We retrospectively reviewed patients treated for refractory CS with VA-ECMO between January 2018 and May 2019. The primary outcome was all-cause mortality within 30 days of VA-ECMO implantation. Secondary outcomes included incidence of major ischemic and bleeding episodes, renal replacement therapy (RRT), and haemolysis. Outcomes were compared between the VA-ECMO cohort and VA-ECMO + percutaneous unloading device (Impella or IABP).

Results: One hundred-one patients were identified: 62 VA-ECMO alone and 39 VA-ECMO + percutaneous unloading (15x Impella, 24x IABP). Thirty-day all-cause mortality was not significantly different in the unloading group (49% vs. 47%; p = 0.849). No difference between secondary outcomes was observed, except for haemolysis, which was greater in unloading group (26.3% vs. 8.9%; p=0.02). V-A ECMO vs. V-A ECMO + unloading of LV complications were as follows: ischaemic stroke 5.3 vs 1.7%, p=0.31; intracerebral bleeding 10.5 vs 1.7%, p=0.052; renal replacement therapy 74.4 vs 66.1, p=0.38; lower limb/foot ischaemia 21.1 vs 16.7%, p= 0.59; mesenteric ischaemia 5.3 vs 6.7%, p=0.78; life threatening or severe bleeding 23.7 vs 37.7%, p=0.15; moderate bleeding 34.2 vs 32.8%, p=0.88.

Conclusion: Addition of Impella or IABP to VA-ECMO did not decrease all-cause mortality at 30 days in patients with refractory cardiogenic shock. We observed an increased incidence of haemolysis, however unloading of LV did not affect safety profiles as compared with VA-ECMO alone.