Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Nov;25(11):2021-2031.
doi: 10.1002/ejhf.3025. Epub 2023 Sep 18.

Impella and venoarterial extracorporeal membrane oxygenation in cardiogenic shock complicating acute myocardial infarction

Margriet Bogerd  1 , Sanne Ten Berg  1 , Elma J Peters  1 , Alexander P J Vlaar  2 , Annemarie E Engström  2 , Luuk C Otterspoor  3 , Christian Jung  4 , Dirk Westermann  5 , Janine Pöss  6 , Holger Thiele  6 , Benedikt Schrage  7 , José P S Henriques  1
Affiliations
Free article
Observational Study

Impella and venoarterial extracorporeal membrane oxygenation in cardiogenic shock complicating acute myocardial infarction

Margriet Bogerd et al. Eur J Heart Fail. 2023 Nov.
Free article

Abstract

Aims: This study aimed to give contemporary insight into the use of Impella and venoarterial extracorporeal membrane oxygenation (VA-ECMO) in acute myocardial infarction-related cardiogenic shock (AMICS) and into associated outcomes, adverse events, and resource demands.

Methods and results: This nationwide observational cohort study describes all AMICS patients treated with Impella (ABIOMED, Danvers, MA, USA) and/or VA-ECMO in 2020-2021. Impella and/or VA-ECMO were used in 20% of all AMICS cases (n = 4088). Impella patients were older (34% vs. 13% >75 years, p < 0.001) and less frequently presented after an out-of-hospital cardiac arrest (18% vs. 40%, p < 0.001). In-hospital mortality was lower in the Impella versus VA-ECMO cohort (61% vs. 67%, p = 0.001). Adverse events occurred less frequently in Impella-supported patients: acute haemorrhagic anaemia (36% vs. 68%, p < 0.001), cerebrovascular accidents (4% vs. 11%, p < 0.001), thromboembolisms of the extremities (5% vs. 8%, p < 0.001), systemic inflammatory response syndrome (21% vs. 25%, p = 0.004), acute kidney injury (44% vs. 53%, p < 0.001), and acute liver failure (7% vs. 12%, p < 0.001). Impella patients were discharged home directly more often (20% vs. 11%, p < 0.001) whereas VA-ECMO patients were more often discharged to another care facility (22% vs. 19%, p = 0.031). Impella patients had shorter hospital stays and lower hospital costs.

Conclusion: This is the largest, most recent European cohort study describing outcomes, adverse events, and resource demands based on claims data in patients with Impella and/or VA-ECMO. Overall, adverse event rates and resource consumption were high. Given the current lack of beneficial evidence, our study reinforces the need for prospectively established, high-quality evidence to guide clinical decision-making.

Keywords: Acute myocardial infarction; Adverse events; Cardiogenic shock; Impella; Resource demands; Venoarterial extracorporeal membrane oxygenation.

PubMed Disclaimer

Comment in

Dataset use reported in

References

    1. Schrage B, Becher PM, Gossling A, Savarese G, Dabboura S, Yan I, et al. Temporal trends in incidence, causes, use of mechanical circulatory support and mortality in cardiogenic shock. ESC Heart Fail 2021;8:1295-1303. https://doi.org/10.1002/ehf2.13202
    1. Shah M, Patnaik S, Patel B, Ram P, Garg L, Agarwal M, et al. Trends in mechanical circulatory support use and hospital mortality among patients with acute myocardial infarction and non-infarction related cardiogenic shock in the United States. Clin Res Cardiol 2018;107:287-303. https://doi.org/10.1007/s00392-017-1182-2
    1. Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med 1999;341:625-634. https://doi.org/10.1056/NEJM199908263410901
    1. Thiele H, Akin I, Sandri M, Fuernau G, de Waha S, Meyer-Saraei R, et al.; CULPRIT-SHOCK Investigators. PCI strategies in patients with acute myocardial infarction and cardiogenic shock. N Engl J Med 2017;377:2419-2432. https://doi.org/10.1056/NEJMoa1710261
    1. Thiele H, Zeymer U, Thelemann N, Neumann FJ, Hausleiter J, Abdel-Wahab M, et al.; IABP-SHOCK II Investigators. Intraaortic balloon pump in cardiogenic shock complicating acute myocardial infarction: Long-term 6-year outcome of the randomized IABP-SHOCK II trial. Circulation 2019;139:395-403. https://doi.org/10.1161/CIRCULATIONAHA.118.038201

Publication types

MeSH terms

LinkOut - more resources