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Comparative Study
. 2025 Feb 4;14(3):e037652.
doi: 10.1161/JAHA.124.037652. Epub 2025 Feb 3.

Effectiveness of an Impella Versus Intra-Aortic Balloon Pump in Patients Who Received Extracorporeal Membrane Oxygenation

Yuji Nishimoto  1 , Hiroyuki Ohbe  2 , Jun Nakata  3 , Toru Takiguchi  4 , Mikio Nakajima  2   5 , Yusuke Sasabuchi  6 , Toshiaki Isogai  2   7 , Hiroki Matsui  2 , Yukihito Sato  8 , Tetsuya Watanabe  1 , Takahisa Yamada  1 , Masatake Fukunami  1 , Hideo Yasunaga  2
Affiliations
Comparative Study

Effectiveness of an Impella Versus Intra-Aortic Balloon Pump in Patients Who Received Extracorporeal Membrane Oxygenation

Yuji Nishimoto et al. J Am Heart Assoc. .

Abstract

Background: It is unclear whether an intra-aortic balloon pump (IABP) or percutaneous ventricular assist device (Impella) in combination with extracorporeal membrane oxygenation (ECMO) is better.

Methods: Using the Japanese Diagnosis Procedure Combination database from September 2016 to March 2022, we identified inpatients who received an Impella or IABP in combination with ECMO (ECPella or ECMO+IABP group, respectively). The primary outcome was in-hospital mortality, and the secondary outcomes included the length of hospital stay, length of ECMO, total hospitalization cost, complications, and durable mechanical circulatory support implantations. Propensity score matching was performed to compare the outcomes between the groups.

Results: Of 14 319 eligible patients, 590 (4.1%) received ECPella and 13 729 (96%) received ECMO+IABP. The mean age of patients was 65 years, 77% were men, and 57% had acute coronary syndrome. After propensity score matching, the patient characteristics were well balanced between the groups. The 14-day mortality rate was lower in the ECPella group than in the ECMO+IABP group (28.0% versus 36.8%; risk difference, -8.2% [95% CI, -13.8 to -2.7]), whereas there was no significant difference in in-hospital mortality between the groups (58.3% versus 56.6%; risk difference, 2.4% [95% CI, -3.5 to 8.2]). The ECPella group had a higher total hospitalization cost, increased renal replacement therapy during hospitalization, and more durable mechanical circulatory support implantations than the ECMO+IABP group.

Conclusions: This nationwide inpatient database study showed no significant difference in in-hospital mortality between the groups, but ECPella was associated with a higher total hospitalization cost, increased renal replacement therapy during hospitalization, and more durable mechanical circulatory support implantations than ECMO+IABP.

Keywords: cardiogenic shock; extracorporeal membrane oxygenation; heart assist device; intra‐aortic balloon pump; mechanical circulatory support.

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Conflict of interest statement

Drs Nishimoto and Nakata received lecture fees from Abiomed Japan. The remaining authors have no disclosures to report.

Figures

Figure 1
Figure 1. Patient flowchart.
ECMO indicates extracorporeal membrane oxygenation; ECPella, combination of extracorporeal membrane oxygenation and Impella; and IABP, intra‐aortic balloon pump.
Figure 2
Figure 2. Kaplan–Meier curves for the 14‐day and 30‐day mortality.
ECMO indicates extracorporeal membrane oxygenation; ECPella, combination of extracorporeal membrane oxygenation and Impella; and IABP, intra‐aortic balloon pump.
See this image and copyright information in PMC

References

    1. Chieffo A, Dudek D, Hassager C, Combes A, Gramegna M, Halvorsen S, Huber K, Kunadian V, Maly J, Møller JE, et al. Joint EAPCI/ACVC expert consensus document on percutaneous ventricular assist devices. Eur Heart J Acute Cardiovasc Care. 2021;10:570–583. doi: 10.1093/ehjacc/zuab015 - DOI - PMC - PubMed
    1. Ostadal P, Rokyta R, Karasek J, Kruger A, Vondrakova D, Janotka M, Naar J, Smalcova J, Hubatova M, Hromadka M, et al. Extracorporeal membrane oxygenation in the therapy of cardiogenic shock: results of the ECMO‐CS randomized clinical trial. Circulation. 2023;147:454–464. doi: 10.1161/CIRCULATIONAHA.122.062949 - DOI - PubMed
    1. Thiele H, Zeymer U, Akin I, Behnes M, Rassaf T, Mahabadi AA, Lehmann R, Eitel I, Graf T, Seidler T, et al. Extracorporeal life support in infarct‐related cardiogenic shock. N Engl J Med. 2023;389:1286–1297. doi: 10.1056/NEJMoa2307227 - DOI - PubMed
    1. Russo JJ, Aleksova N, Pitcher I, Couture E, Parlow S, Faraz M, Visintini S, Simard T, di Santo P, Mathew R, et al. Left ventricular unloading during extracorporeal membrane oxygenation in patients with cardiogenic shock. J Am Coll Cardiol. 2019;73:654–662. doi: 10.1016/j.jacc.2018.10.085 - DOI - PubMed
    1. Schrage B, Becher PM, Bernhardt A, Bezerra H, Blankenberg S, Brunner S, Colson P, Cudemus Deseda G, Dabboura S, Eckner D, et al. Left ventricular unloading is associated with lower mortality in patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation: results from an international, multicenter cohort study. Circulation. 2020;142:2095–2106. doi: 10.1161/CIRCULATIONAHA.120.048792 - DOI - PMC - PubMed

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