TY - JOUR
T1 - Bridging INTERMACS 1 patients from VA-ECMO to LVAD via Impella 5.0
T2 - De-escalate and ambulate
AU - Bertoldi, Letizia F.
AU - Pappalardo, Federico
AU - Lubos, Edith
AU - Grahn, Hanno
AU - Rybczinski, Meike
AU - Barten, Markus J.
AU - Legros, Tim
AU - Bertoglio, Luca
AU - Schrage, Benedikt
AU - Westermann, Dirk
AU - Lapenna, Elisabetta
AU - Reichenspurner, Hermann
AU - Bernhardt, Alexander M.
N1 - Publisher Copyright:
© 2019
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/6
Y1 - 2020/6
N2 - 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.
AB - 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.
KW - Cardiogenic shock
KW - Impella 5.0
KW - Left ventricular assist device
KW - Veno-arterial extracorporeal membrane oxygenation
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U2 - 10.1016/j.jcrc.2019.12.028
DO - 10.1016/j.jcrc.2019.12.028
M3 - Article
C2 - 32061461
AN - SCOPUS:85079372051
VL - 57
SP - 259
EP - 263
JO - Journal of Critical Care
JF - Journal of Critical Care
SN - 0883-9441
ER -