Cardiogenic Shock Spectrum: Outcomes Utilizing VA ECMO with or without Axillary Impella 5.0: Single Center Experience

Purpose VA ECMO is often used as a rescue therapy for rapid hemodynamic stabilization due to acute refractory cardiogenic shock, while elective Impella 5.0 is often a planned strategy as part of a long-term heart failure surgical option. The objective of this study is to evaluate the differences in outcomes depending on which form of mechanical support was used. Methods Retrospective review of all patients with an Impella 5.0 or VA ECMO between January 2018 to September 2019. Results A total of 138 patients were placed on either VA ECMO or Impella 5.0. Of these, 39 patients received an Impella, 116 patients were placed on VA ECMO, and 17 patients received an Impella with concurrent VA-ECMO (EC-Pella). Of the 22 Impella 5.0 only patients, survival to discharge was 90% (n= 20) of which 55% (n= 12) had durable LVAD, 27% (n= 6) heart transplant. Survival to discharge was 58% for VA ECMO patients (n= 57), and 53% in patients requiring EC-Pella (n= 9). Though the survival to discharge rate decreased for both VA ECMO and EC-Pella when compared to Impella 5.0 alone, the acuity of patients requiring ECMO support was considerably higher than patients on Impella 5.0 alone. Conclusion VA ECMO is often utilized in patients in rapid hemodynamic decline and improves survival, however, the addition of Impella 5.0 did not significantly change the survival if there is no long term exit strategy.