Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
J Crit Care. 2020 Jun;57:253-258. doi: 10.1016/j.jcrc.2019.11.007.
Various options of temporary mechanical circulatory support (tMCS) exist for the treatment of cardiogenic shock, however, all forms of tMCS carry a risk of complications. The aim of this study was to compare bleeding complications and thromboembolic events under extracorporeal life support + Impella 2.5/CP (ECMELLA) and isolated Impella 5.0 therapy in the same patient cohort.
We retrospectively analyzed data of patients who underwent ECMELLA implantation and subsequent Impella 5.0 therapy. Implantation strategy and anticoagulation protocol were comparable in both groups.
We included 15 patients (mean age 57.2 years; 80% of male patients) who were weaned from ECMELLA undergoing subsequent Impella 5.0 implantation. Mean duration of ECMELLA and Impella 5.0 therapy (10.5 vs. 11.2 days) did not differ significantly (p = .731). The average number of transfused packed red blood cells (PRBC) and thrombocyte concentrates (TC) was significantly decreased during Impella 5.0 treatment (PRBC: 30.3 vs 12.3, p = .001; TC: 5.9 vs 2.2, p = .045). Additionally, the transfusion rates per day were significantly reduced under Impella 5.0 support.
The need for transfusions is significantly lower in the phase of Impella 5.0 therapy compared to the initial phase on ECMELLA. Therefore, we recommend replacing ECMELLA by an Impella 5.0 device early, if possible.
针对心源性休克的治疗，存在多种临时机械循环支持（tMCS）选择，但所有形式的 tMCS 都有发生并发症的风险。本研究旨在比较体外生命支持+Impella 2.5/CP（ECMELLA）和单独使用 Impella 5.0 治疗时同一患者队列中的出血并发症和血栓栓塞事件。
我们回顾性分析了接受 ECMELLA 植入术和随后接受 Impella 5.0 治疗的患者数据。两组的植入策略和抗凝方案相似。
我们纳入了 15 名患者（平均年龄 57.2 岁；80%为男性），他们在从 ECMELLA 脱机后接受了随后的 Impella 5.0 植入。ECMELLA 和 Impella 5.0 治疗的平均持续时间（10.5 天与 11.2 天）无显著差异（p=0.731）。在接受 Impella 5.0 治疗期间，输注的浓缩红细胞（PRBC）和血小板浓缩物（TC）的平均数量显著减少（PRBC：30.3 与 12.3，p=0.001；TC：5.9 与 2.2，p=0.045）。此外，Impella 5.0 支持下的每日输血率也显著降低。
与初始的 ECMELLA 阶段相比，在 Impella 5.0 治疗阶段的输血需求显著降低。因此，如果可能的话，我们建议尽早用 Impella 5.0 设备替代 ECMELLA。
