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

Ardito, Vittoria; Sarucanian, Lilit; Rognoni, Carla; Pieri, Marina; Scandroglio, Anna Mara; Tarricone, Rosanna

doi:10.2139/ssrn.4340499

Cited by 2 publications

(1 citation statement)

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“…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 intraaortic 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.…”

Section: Acute Myocardial Infarctionmentioning

confidence: 99%

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

Salazar,

Lorusso

2024

Current Opinion in Critical Care

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Purpose of review To examine the evolving landscape of cardiac surgery, focusing on the increasing complexity of patients and the role of mechanical circulatory support (MCS) in managing perioperative low cardiac output syndrome (P-LCOS). Recent findings P-LCOS is a significant predictor of mortality in cardiac surgery patients. Preoperative risk factors, such as cardiogenic shock and elevated lactate levels, can help identify those at higher risk. Proactive use of MCS, rather than reactive implementation after P-LCOS develops, may lead to improved outcomes by preventing severe organ hypoperfusion. The emerging concept of “protected cardiac surgery” emphasizes early identification of these high-risk patients and planned MCS utilization. Additionally, specific MCS strategies are being developed and refined for various cardiac conditions, including AMI-CS, valvular surgeries, and pulmonary thromboendarterectomy. Summary This paper explores the shifting demographics and complexities in cardiac surgery patients. It emphasizes the importance of proactive, multidisciplinary approaches to identify high-risk patients and implement early MCS to prevent P-LCOS and improve outcomes. The concept of protected cardiac surgery, involving planned MCS use and shared decision-making, is highlighted. The paper also discusses MCS strategies tailored to specific cardiac procedures and the ethical considerations surrounding MCS implementation.

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Section: Acute Myocardial Infarctionmentioning

confidence: 99%

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

Salazar,

Lorusso

2024

Current Opinion in Critical Care

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

Martínez-Sellés,

García Carreño,

Martínez-Solano

et al. 2023

JVD

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Background: Previous studies suggest variability in the management of cardiogenic shock (CS). Methods: An anonymous survey was sent to Spanish hospitals. Results: We obtained 50 answers, mainly from cardiologists (36–72%). The annual average of ECMOs is 16.7 ± 11.3 applications in CS patients and of Impellas is 8.7 ± 8.3 applications in CS patients. Intra-aortic balloon counterpulsation is used in the majority of CS ECMOs (31–62%), and Impella is used in 7 (14%). In 36 (72%) cases, ECMO is used as a treatment for cardiac arrest. In 10 cases, ECMO removal is percutaneous (20%). In 25 (50%) cases, age is a relative contraindication; 17 have a mobile ECMO team (34%); and 23 (46%) have received ECMO patients from other centers in the last year. Pre-purged ECMO is only used in 16 (32%). ECMO implantation is carried out under ultrasound guidance in 31 (62%), only with angiography in 3 (6%) and with both in 11 (22%). The Swan–Ganz catheter is used routinely in 8 (16%), only in doubtful cases in 24 (48%), and in most cases in 8 (16%). The ECMO awake strategy is used little or not at all in 28 (56%), in selected cases in 17 (34%), and routinely in 5 (10%). Conclusion: Our study shows a huge variation in the management of patients with CS.

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

Cited by 2 publications

References 0 publications

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

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

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

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