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Updated: Jun 24, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Left ventricular unloading via percutaneous assist device during extracorporeal membrane oxygenation in acute
Jake M Kieserman1, Ivan A Kuznetsov1, Joseph Park1
1Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Insights
In patients with acute myocardial infarction (AMI) and cardiac arrest (CA), venoarterial extracorporeal membrane oxygenation (VA-ECMO) alone versus ECPELLA (VA-ECMO with Impella) showed no significant 6-month mortality difference. Further randomized trials are needed to confirm these findings.
Area of Science:
- Cardiology
- Critical Care Medicine
- Mechanical Circulatory Support
Background:
- Acute myocardial infarction (AMI) can lead to cardiac arrest (CA) and cardiogenic shock (CS).
- Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used for CS, often with an Impella device (ECPELLA), but evidence is limited.
- The combination of VA-ECMO and Impella aims to support circulation and unload the left ventricle in AMI patients.
Purpose of the Study:
- To compare the 6-month all-cause mortality between VA-ECMO alone and ECPELLA in patients with AMI, CA, and CS.
- To evaluate in-hospital mortality and complication rates between the two treatment groups.
- To assess the impact of ECPELLA on patient outcomes compared to VA-ECMO alone.
Main Methods:
- Retrospective chart review of 50 patients with AMI-CS and CA.
- Patients were supported with either VA-ECMO (n=34) or ECPELLA (n=16).
- Primary outcome was 6-month all-cause mortality; secondary outcomes included in-hospital mortality and complications.
Main Results:
- Baseline characteristics were similar between groups.
- The ECPELLA cohort had a worse predicted survival score (SAVE score).
- No significant difference in 6-month all-cause mortality was observed between VA-ECMO and ECPELLA groups, even after adjusting for SAVE score. The ECPELLA group had more minor complications but not more major ones.
Conclusions:
- Current evidence does not show a mortality benefit for ECPELLA over VA-ECMO alone in AMI patients with CA and CS.
- Further randomized controlled trials are necessary to definitively establish the comparative effectiveness of these mechanical circulatory support strategies.
- The findings suggest a need for more robust clinical trials to guide treatment decisions in this high-risk patient population.
Introduction:
A feared complication of an acute myocardial infarction (AMI) is cardiac arrest (CA). Even if return of spontaneous circulation is achieved, cardiogenic shock (CS) is common. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) supports patients with CS and is often used in conjunction with an Impella device (2.5 and CP) to off-load the left ventricle, although limited evidence supports this approach.
Methods:
The goal of this study was to determine whether a mortality difference was observed in VA-ECMO alone versus VA-ECMO with Impella (ECPELLA) in patients with CS from AMI and CA. A retrospective chart review of 50 patients with AMI-CS and CA and were supported with VA-ECMO (n = 34) or ECPELLA (n = 16) was performed. The primary outcome was all-cause mortality at 6-months from VA-ECMO or Impella implantation. Secondary outcomes included in-hospital mortality and complication rates between both cohorts and intensive care unit data.
Results:
Baseline characteristics were similar, except patients with ST-elevation myocardial infarction were more likely to be in the VA-ECMO group (p = 0.044). The ECPELLA cohort had significantly worse survival after VA-ECMO (SAVE) score (p = 0.032). Six-month all-cause mortality was not significantly different between the cohorts, even when adjusting for SAVE score. Secondary outcomes were notable for an increased rate of minor complications without an increased rate of major complications in the ECPELLA group.
Conclusions:
Randomized trials are needed to determine if a mortality difference exists between VA-ECMO and ECPELLA platforms in patients with AMI complicated by CA and CS.
