Balder Jan-Willem, Szymanski Mariusz K, van Laake Linda W, van der Harst Pim, Meuwese Christiaan L, Ramjankhan Faiz Z, van der Meer Manon G, Hermens Jeannine A J M, Voskuil Michiel, de Waal Eric E C, Donker Dirk W, Oerlemans Marish I F J, Kraaijeveld Adriaan O
Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
Neth Heart J. 2024 Jun;32(6):245-253. doi: 10.1007/s12471-024-01872-w. Epub 2024 May 7.
In refractory cardiogenic shock, temporary mechanical support (tMCS) may be crucial for maintaining tissue perfusion and oxygen delivery. tMCS can serve as a bridge-to-decision to assess eligibility for left ventricular assist device (LVAD) implantation or heart transplantation, or as a bridge-to-recovery. ECPELLA is a novel tMCS configuration combining venoarterial extracorporeal membrane oxygenation with Impella. The present study presents the clinical parameters, outcomes, and complications of patients supported with ECPELLA.
All patients supported with ECPELLA at University Medical Centre Utrecht between December 2020 and August 2023 were included. The primary outcome was 30-day mortality, and secondary outcomes were LVAD implantation/heart transplantation and safety outcomes.
Twenty patients with an average age of 51 years, and of whom 70% were males, were included. Causes of cardiogenic shock were acute heart failure (due to acute coronary syndrome, myocarditis, or after cardiac surgery) or chronic heart failure, respectively 70 and 30% of cases. The median duration of ECPELLA support was 164 h (interquartile range 98-210). In 50% of cases, a permanent LVAD was implanted. Cardiac recovery within 30 days was seen in 30% of cases and 30-day mortality rate was 20%. ECPELLA support was associated with major bleeding (40%), haemolysis (25%), vascular complications (30%), kidney failure requiring replacement therapy (50%), and Impella failure requiring extraction (15%).
ECPELLA can be successfully used as a bridge to LVAD implantation or as a bridge-to-recovery in patients with refractory cardiogenic shock. Despite a significant number of complications, 30-day mortality was lower than observed in previous cohorts.
在难治性心源性休克中，临时机械支持（tMCS）对于维持组织灌注和氧输送可能至关重要。tMCS可作为评估左心室辅助装置（LVAD）植入或心脏移植资格的决策桥梁，或作为恢复桥梁。ECPELLA是一种将静脉-动脉体外膜肺氧合与Impella相结合的新型tMCS配置。本研究展示了接受ECPELLA支持的患者的临床参数、结局和并发症。
纳入2020年12月至2023年8月期间在乌得勒支大学医学中心接受ECPELLA支持的所有患者。主要结局为30天死亡率，次要结局为LVAD植入/心脏移植和安全性结局。
纳入20例患者，平均年龄51岁，其中70%为男性。心源性休克的病因分别为急性心力衰竭（由于急性冠状动脉综合征、心肌炎或心脏手术后）或慢性心力衰竭，各占70%和30%的病例。ECPELLA支持的中位持续时间为164小时（四分位间距98 - 210）。50%的病例植入了永久性LVAD。30%的病例在30天内实现心脏恢复，30天死亡率为20%。ECPELLA支持与严重出血（40%）、溶血（25%）、血管并发症（30%）、需要替代治疗的肾衰竭（50%）以及需要拔除的Impella故障（15%）相关。
ECPELLA可成功用作难治性心源性休克患者LVAD植入的桥梁或恢复桥梁。尽管并发症数量众多，但30天死亡率低于先前队列中的观察值。
