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.