Trends in Veno-Arterial Extracorporeal Life Support With and Without an Impella or Intra-Aortic Balloon Pump for Cardiogenic Shock

• Authors: Michael J Hendrickson, Harvard Medical School; Vardhmaan Jain, Emory University; Kirtipal Bhatia, Mt Sinai St Lukes Hosp; Christopher Chew, University of North Carolina; Sameer Arora, University of North Carolina; Joseph S Rossi, University of North Carolina; Pedro Villablanca, Henry Ford Hospital; Navin K Kapur, Tufts Med Ctr; Aditya A Joshi, University of Washington; Arieh Fox, Icahn School of Medicine at Mount Sinai; Kiran Mahmood, Icahn School of Medicine at Mount Sinai; Edo Y Birati, Bar Ilan University; Mark J Ricciardi, University of Chicago; Arman Qamar, University of Chicago
• Journal Title: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• Volume: Volume 11, Number 23
• Publisher: WILEY | 2022-12-06, Pages e025216-e025216
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1161/JAHA.121.025216
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; cardiogenic shock; Impella; intra-aortic balloon pump; mechanical circulatory support; MEMBRANE-OXYGENATION; ICD-9-CM

Abstract

BACKGROUND: Mechanical circulatory support devices, such as the intra-aortic balloon pump (IABP) and Impella, are often used in patients on veno-arterial extracorporeal life support (VA-ECLS) with cardiogenic shock despite limited supporting clinical trial data. METHODS AND RESULTS: Hospitalizations for cardiogenic shock from 2016 to 2018 were identified from the National Inpatient Sample. Trends in the use of VA-ECLS with and without an IABP or Impella were assessed semiannually. Multivariable logistic regression and general linear regression evaluated the association of Impella and IABP use with in-hospital outcomes. Overall, 12 035 hospitalizations with cardiogenic shock and VA-ECLS were identified, of which 3115 (26%) also received an IABP and 1880 (16%) an Impella. Use of an Impella with VA-ECLS substantially increased from 10% to 18% over this period (P<0.001), whereas an IABP modestly increased from 25% to 26% (P<0.001). In-hospital mortality decreased 54% to 48% for VA-ECLS only, 61% to 58% for VA-ECLS with an Impella, and 54% to 49% for VA-ECLS with an IABP (P<0.001 each). Most (57%) IABPs or Impellas were placed on the same day as VA-ECLS. After adjustment, there were no differences in in-hospital mortality or length of stay with the addition of an IABP or Impella compared with VA-ECLS alone. CONCLUSIONS: From 2016 to 2018 in the United States, use of an Impella and IABP with VA-ECLS significantly increased. More than half of Impellas and IABPs were placed on the same day as VA-ECLS, and the use of a second mechanical circulatory support device did not impact in-hospital mortality. Further studies are needed to decipher the optimal timing and patient selection for this growing practice.