Purpose of the study: In patients with extracorporeal life support (ECLS) in cardiogenic shock, increased left ventricular afterload might reduce left ventricular ejection fraction and lead to pulmonary congestion. Percutaneous ventricular assist devices (PVAD) like the Impella® device (Abiomed, Danvers, MA) can be used for left ventricular (LV) unloading and might reduce afterload in ECLS patients.

Materials and methods: In a retrospective monocentric registry study, we included 17 consecutive patients in cardiogenic shock supported with ECLS combined with PVAD for LV-unloading between April 2014 and April 2017. Patients’ baseline characteristics were collected at initiation of therapy and outcomes after 30 days.

Results: Mean duration of ECLS was 9 days (range: 4 days – 19 days), mean duration of PVAD was 5 days (range: 1 day – 9 days). 30-day-survival was 24% (4/17). 10 patients (59%) died due to severe post resuscitation syndrome with profound cardiogenic shock, 2 patients (12%) died of cerebral hypoxia and 1 patient (6%) in severe multi-organ failure.
Survivors (mean age: 34.7 yrs., range: 21-61 yrs.) were all diagnosed with myocarditis, while in non-survivors, 8 were cannulated during cardiac arrest due to acute myocardial infarction, septic shock (4/17) or primary ventricular fibrillation (1/17). Severe vascular complications were recorded in 3/17 patients (18%) with compartment syndrome needing fasciotomy in two patients and peripheral hypo-perfusion despite full ECLS and PVAD support necessitating amputation in one patient. Predictors of survival were PVAD in myocarditis and younger patient age. 

Conclusions: LV-venting by PVAD in ECLS patients is feasible. Especially in younger patients suffering from myocarditis, this might be a promising therapy. In patients with post-resuscitation syndrome, we could not show any benefit of PVAD therapy. Complications have to be taken into consideration and have to be addressed in larger case series in order to estimate a net clinical benefit.

Left ventricular unloading during extracorporeal life support (ECLS) by percutaneous ventricular assist device (PVAD) therapy in patients with severe cardiogenic shock