Impella Versus VA-ECMO for Patients with Cardiogenic Shock: Comprehensive Systematic Literature Review and Meta-Analyses

Abstract

Impella and VA-ECMO are two possible therapeutic courses for the treatment of patients with cardiogenic shock (CS). The study aims to perform a systematic literature review and meta-analyses of a comprehensive set of clinical and socio-economic outcomes observed when using Impella or VA-ECMO with patients under CS. A systematic literature review was performed in Medline, and Web of Science databases on 21 February 2022. Nonoverlapping studies with adult patients supported for CS with Impella or VA-ECMO were searched. Study designs including RCTs, observational studies, and economic evaluations were considered. Data on patient characteristics, type of support, and outcomes were extracted. Additionally, meta-analyses were performed on the most relevant and recurring outcomes, and results shown using forest plots. A total of 102 studies were included, 57% on Impella, 43% on VA-ECMO. The most common outcomes investigated were mortality/survival, duration of support, and bleeding. Ischemic stroke was lower in patients treated with Impella compared to the VA-ECMO population, with statistically significant difference. Socio-economic outcomes including quality of life or resource use were not reported in any study. The study highlighted areas where further data collection is needed to clarify the value of complex, new technologies in the treatment of CS that will enable comparative assessments focusing both on the health impact on patient outcomes and on the financial burden for government budgets. Future studies need to fill the gap to comply with recent regulatory updates at the European and national levels.

Has the role of veno-arterial extracorporeal membrane oxygenation in patients with cardiogenic shock following acute myocardial infarction been fully determined? A case report

“… 9 Reports suggest that Impella’s role is comparable with VA ECMO in AMI-complicated CS, but accessibility remains an issue in developing countries like Vietnam. 10 Moreover, the ECLS-SHOCK study did not report the VIS—a highly relevant index for determining the need for VA ECMO and predicting patient outcomes. 11 The VIS is a numeric index used to measure cardiovascular support in shock patients, with higher scores indicating a more severe condition and poorer prognoses.…”

Survey on Cardiogenic Shock and the Use of ECMO and Impella in Spanish Cardiac Critical Care Units

“…In our survey, venoarterial ECMO use was double that of Impella. Although recent data that have suggested a benefit of Impella compared to ECMO [5,6] are difficult to interpret as ECMO-treated patients usually have a more severe CS. In addition, cost might also be a reason for the lower use of Impella, although recent studies have suggested that Impella is cost-effective [22].…”

“…Their results are not easy to compare, as ECMO is usually preferred in more advanced types of CS with severe respiratory failure and/or biventricular ventricular systolic dysfunction. Therefore, recent data that have suggested a benefit of Impella compared to ECMO [5,6] are difficult to interpret as ECMO-treated patients frequently have a more severe CS and are more prone to infections and other complications [7]. In addition, the newest anticoagulation strategies, both for ECMO [8][9][10] and Impella [11][12][13], can also affect the complication rate in these patients.…”

Protected cardiac surgery: strategic mechanical circulatory support to improve postcardiotomy mortality

“…Left-to-right shunt with significant RV dysfunction leads to LV-RV overload and lung congestion. In such situations, combining VA-ECMO with unloading devices like intra-aortic balloon pump (IABP) or IMPELLA (ECPELLA) may be necessary to achieve optimal hemodynamic goals [41,42]. When RV function is preserved, IMPELLA support has shown promise.…”