Introduction
The frequency of extracorporeal cardiopulmonary resuscitation (eCPR),
either in out-of-hospital or in-hospital cardiac arrest (OHCA / IHCA)
scenarios, is increasing due to advances in interdisciplinary treatment
of these patients (1). Moreover, mortality rates have been shown to be
improving in recent years, despite still relatively low overall-survival
(2). In particular, eCPR remains a specialized rescue-therapy and is
mainly performed in high volume centers (3, 4).
In eCPR patients, left ventricular function might be massively impaired
due to myocardial infarction (MI), decompensated heart insufficiency
(HI), pulmonary embolism (PE), or a primary arrhythmogenic event.
Furthermore, experimental data show that due to its retrograde flow,
VA-ECMO causes left ventricular (LV) distension and an increase in left
ventricular end-diastolic volume (LVEDV), left ventricular end-systolic
volume (LVESV), as well as increased myocardial wall stress (5). The
potential formation of an LV-thrombus is a fatal consequence of impaired
and dilated LV without sufficient ejection (6).
Several strategies are being discussed to avoid or limit left
ventricular dilation (7). Up to now, there are no particular indications
for LV-unloading regimes and no specific guidelines (8). The decision
for LV- unloading is depending on clinical parameters, such as
echocardiographic measures, radiological findings, and the hemodynamic
situation (9). The question of routine implementation of LV unloading or
selection of appropriate parameters and patients is the subject of a
widespread scientific work in recent literature (9-11).
In clinical practice, short-term left ventricular assist with Impella®
is frequently used for LV- unloading in ECMO patients (11). Besides
beneficial hemodynamic effects, differences in favorable clinical
outcomes might be affected by the underlying disease.
In this regard, we sought to analyze the effect of concomitant Impella®
implantation in eCPR patients in order to analyze the impact on
short-term outcomes.