Bridging INTERMACS 1 patients from VA-ECMO to LVAD via Impella 5.0: De-escalate and ambulate
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Bridging INTERMACS 1 patients from VA-ECMO to LVAD via Impella 5.0: De-escalate and ambulate. / Bertoldi, Letizia F; Pappalardo, Federico; Lubos, Edith; Grahn, Hanno; Rybczinski, Meike; Barten, Markus J; Legros, Tim; Bertoglio, Luca; Schrage, Benedikt; Westermann, Dirk; Lapenna, Elisabetta; Reichenspurner, Hermann; Bernhardt, Alexander M.
In: J CRIT CARE, Vol. 57, 06.2020, p. 259-263.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Bridging INTERMACS 1 patients from VA-ECMO to LVAD via Impella 5.0: De-escalate and ambulate
AU - Bertoldi, Letizia F
AU - Pappalardo, Federico
AU - Lubos, Edith
AU - Grahn, Hanno
AU - Rybczinski, Meike
AU - Barten, Markus J
AU - Legros, Tim
AU - Bertoglio, Luca
AU - Schrage, Benedikt
AU - Westermann, Dirk
AU - Lapenna, Elisabetta
AU - Reichenspurner, Hermann
AU - Bernhardt, Alexander M
N1 - Copyright © 2019. Published by Elsevier Inc.
PY - 2020/6
Y1 - 2020/6
N2 - PURPOSE: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) stabilizes patients in refractory cardiogenic shock. However, ECMO-related complications strongly affect the outcome, especially if a long-term LVAD is needed.METHODS AND MATERIALS: We describe a new strategy in management of INTERMACS 1 patients consisting in early weaning from VA-ECMO with axillary Impella 5.0 as a bridge to LVAD implantation. Nine patients in two European centres are described.RESULTS: All patients were implanted with VA-ECMO for initial hemodynamic and metabolic stabilization. After a median time of 8 days, Impella 5.0 was implanted. Impella support allowed in all patients weaning from inotropes and from VA-ECMO (after a median time of 22 h). No patients had right ventricular failure after ECMO-weaning and most patients were mobilized and orally fed (88.9%) during Impella support. All patient underwent LVAD implantation after a median Impella time of 17 days. Only one patient had right-ventricular failure after LVAD implantation. All patients were discharged from hospital after a median time of 40 days.CONCLUSION: Early weaning from VA-ECMO with Impella 5.0 as a bridge to LVAD is a safe and effective strategy in management of INTERMACS 1 patients. This approach minimizes ECMO-related complications and allows patient mobilization and right ventricular function optimization before LVAD implantation.
AB - PURPOSE: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) stabilizes patients in refractory cardiogenic shock. However, ECMO-related complications strongly affect the outcome, especially if a long-term LVAD is needed.METHODS AND MATERIALS: We describe a new strategy in management of INTERMACS 1 patients consisting in early weaning from VA-ECMO with axillary Impella 5.0 as a bridge to LVAD implantation. Nine patients in two European centres are described.RESULTS: All patients were implanted with VA-ECMO for initial hemodynamic and metabolic stabilization. After a median time of 8 days, Impella 5.0 was implanted. Impella support allowed in all patients weaning from inotropes and from VA-ECMO (after a median time of 22 h). No patients had right ventricular failure after ECMO-weaning and most patients were mobilized and orally fed (88.9%) during Impella support. All patient underwent LVAD implantation after a median Impella time of 17 days. Only one patient had right-ventricular failure after LVAD implantation. All patients were discharged from hospital after a median time of 40 days.CONCLUSION: Early weaning from VA-ECMO with Impella 5.0 as a bridge to LVAD is a safe and effective strategy in management of INTERMACS 1 patients. This approach minimizes ECMO-related complications and allows patient mobilization and right ventricular function optimization before LVAD implantation.
KW - Adult
KW - Extracorporeal Membrane Oxygenation/instrumentation
KW - Female
KW - Follow-Up Studies
KW - Heart Failure/therapy
KW - Heart-Assist Devices
KW - Hemodynamics
KW - Humans
KW - Male
KW - Middle Aged
KW - Research Design
KW - Retrospective Studies
KW - Shock, Cardiogenic/therapy
KW - Ventricular Function, Right
U2 - 10.1016/j.jcrc.2019.12.028
DO - 10.1016/j.jcrc.2019.12.028
M3 - SCORING: Journal article
C2 - 32061461
VL - 57
SP - 259
EP - 263
JO - J CRIT CARE
JF - J CRIT CARE
SN - 0883-9441
ER -