Bridging INTERMACS 1 patients from VA-ECMO to LVAD via Impella 5.0: De-escalate and ambulate

Letizia F. Bertoldi, Federico Pappalardo, Edith Lubos, Hanno Grahn, Meike Rybczinski, Markus J. Barten, Tim Legros, Luca Bertoglio, Benedikt Schrage, Dirk Westermann, Elisabetta Lapenna, Hermann Reichenspurner, Alexander M. Bernhardt

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) stabilizes patients in refractory cardiogenic shock. However, ECMO-related complications strongly affect the outcome, especially if a long-term LVAD is needed. Methods and materials: We describe a new strategy in management of INTERMACS 1 patients consisting in early weaning from VA-ECMO with axillary Impella 5.0 as a bridge to LVAD implantation. Nine patients in two European centres are described. Results: All patients were implanted with VA-ECMO for initial hemodynamic and metabolic stabilization. After a median time of 8 days, Impella 5.0 was implanted. Impella support allowed in all patients weaning from inotropes and from VA-ECMO (after a median time of 22 h). No patients had right ventricular failure after ECMO-weaning and most patients were mobilized and orally fed (88.9%) during Impella support. All patient underwent LVAD implantation after a median Impella time of 17 days. Only one patient had right-ventricular failure after LVAD implantation. All patients were discharged from hospital after a median time of 40 days. Conclusion: Early weaning from VA-ECMO with Impella 5.0 as a bridge to LVAD is a safe and effective strategy in management of INTERMACS 1 patients. This approach minimizes ECMO-related complications and allows patient mobilization and right ventricular function optimization before LVAD implantation.

Original languageEnglish
Pages (from-to)259-263
Number of pages5
JournalJournal of Critical Care
Volume57
DOIs
Publication statusPublished - Jun 2020

Keywords

  • Cardiogenic shock
  • Impella 5.0
  • Left ventricular assist device
  • Veno-arterial extracorporeal membrane oxygenation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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