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Practical Management of ECPELLA.
Makiko Nakamura1, Teruhiko Imamura1
1Second Department of Internal Medicine, University of Toyama.
International Heart Journal
|October 29, 2020
Summary
Veno-arterial extracorporeal membrane oxygenation (ECMO) can increase left ventricular afterload. Combining ECMO with Impella support (ECPELLA) unloads the left ventricle, offering a promising approach for cardiogenic shock management.
Area of Science:
- Cardiology
- Mechanical Circulatory Support
Background:
- Veno-arterial extracorporeal membrane oxygenation (ECMO) is a vital treatment for cardiogenic shock but increases left ventricular afterload.
- The Impella device unloads the left ventricle but may have insufficient flow for complete hemodynamic support.
Purpose of the Study:
- To evaluate the use of combined ECMO and Impella support (ECPELLA) for managing cardiogenic shock.
- To highlight the role of the pulmonary artery pulsatility index in managing ECPELLA.
Main Methods:
- Review of current clinical practices and literature regarding ECPELLA.
- Discussion of the pulmonary artery pulsatility index as a monitoring tool for ECPELLA.
Main Results:
- ECPELLA combines systemic circulation support with left ventricular unloading.
- The pulmonary artery pulsatility index is a useful indicator for maintaining ECPELLA.
Conclusions:
- ECPELLA is an increasingly utilized strategy for severe cardiogenic shock.
- Larger studies are needed to confirm the clinical advantages of ECPELLA over conventional ECMO.
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