Trends in Veno-Arterial Extracorporeal Life Support With and Without an Impella or Intra-Aortic Balloon Pump for Cardiogenic Shock

Michael J. Hendrickson, Vardhmaan Jain, Kirtipal Bhatia, Christopher Chew, Sameer Arora, Joseph S. Rossi, Pedro Villablanca, Navin K. Kapur, Aditya A. Joshi, Arieh Fox, Kiran Mahmood, Edo Y. Birati, Mark J. Ricciardi, Arman Qamar

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

BACKGROUND: Mechanical circulatory support devices, such as the intra-aortic balloon pump (IABP) and Impella, are often used in patients on veno-arterial extracorporeal life support (VA-ECLS) with cardiogenic shock despite limited supporting clinical trial data. METHODS AND RESULTS: Hospitalizations for cardiogenic shock from 2016 to 2018 were identified from the National Inpatient Sample. Trends in the use of VA-ECLS with and without an IABP or Impella were assessed semiannually. Multivariable logistic regression and general linear regression evaluated the association of Impella and IABP use with in-hospital outcomes. Overall, 12 035 hospitalizations with cardiogenic shock and VA-ECLS were identified, of which 3115 (26%) also received an IABP and 1880 (16%) an Impella. Use of an Impella with VA-ECLS substantially increased from 10% to 18% over this period (P<0.001), whereas an IABP modestly increased from 25% to 26% (P<0.001). In-hospital mortality decreased 54% to 48% for VA-ECLS only, 61% to 58% for VA-ECLS with an Impella, and 54% to 49% for VA-ECLS with an IABP (P<0.001 each). Most (57%) IABPs or Impellas were placed on the same day as VA-ECLS. After adjustment, there were no differences in in-hospital mortality or length of stay with the addition of an IABP or Impella compared with VA-ECLS alone. CONCLUSIONS: From 2016 to 2018 in the United States, use of an Impella and IABP with VA-ECLS significantly increased. More than half of Impellas and IABPs were placed on the same day as VA-ECLS, and the use of a second mechanical circulatory support device did not impact in-hospital mortality. Further studies are needed to decipher the optimal timing and patient selection for this growing practice.

Original languageEnglish
Article numbere7896
JournalJournal of the American Heart Association
Volume11
Issue number23
DOIs
StatePublished - 6 Dec 2022

Bibliographical note

Publisher Copyright:
© 2022 The Authors.

Funding

Dr Ricciardi receives consulting and speaker support from Abiomed. Dr Qamar reports receiving institutional grant support from Novo Nordisk, NorthShore Auxiliary Research Scholar Fund, NorthShore CardioDiabetes Pilot Grant, and fees for educational activities from the American College of Cardiology, Society for Vascular Medicine, Society for Cardiovascular Angiography and Interventions, Janssen and Janssen, Pfizer, Medscape, and the Clinical Exercise Physiology Association. The remaining authors report no disclosures, financial or otherwise.

FundersFunder number
Clinical Exercise Physiology Association
NorthShore Auxiliary Research
NorthShore CardioDiabetes
Novo Nordisk

    Keywords

    • Impella
    • cardiogenic shock
    • intra-aortic balloon pump
    • mechanical circulatory support

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