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Updated: Jun 22, 2025
Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
Transcatheter Axial Pump Use in Pediatric Patients on Veno-Arterial Extracorporeal Membrane Oxygenation: An ACTION
Svetlana B Shugh1, Sebastian C Tume2, Neha Bansal3
1From The Division of Pediatric Cardiology, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, Florida.
Insights
In pediatric patients on VA-ECMO, Impella support can aid recovery or transition to VAD/transplant. This study shows Impella use in this population is associated with low mortality and positive outcomes.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Extracorporeal Membrane Oxygenation
Background:
- Cardiogenic shock in children often requires advanced mechanical circulatory support.
- Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a common therapy, but may require additional left ventricular support.
- The use of Impella percutaneous pumps in conjunction with VA-ECMO in pediatrics is not well-established.
Purpose of the Study:
- To report the largest pediatric multicenter experience with Impella pump use and peripheral VA-ECMO support.
- To evaluate the outcomes of pediatric patients requiring VA-ECMO support with subsequent Impella implant.
- To assess the safety and efficacy of Impella as a bridge to recovery, durable ventricular assist device (VAD), or transplantation.
Main Methods:
- Retrospective, multicenter study using the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) collaborative database.
- Included pediatric patients with cardiogenic shock requiring VA-ECMO support with subsequent Impella implant (October 2014 - December 2021).
- Primary outcome: death on Impella support. Secondary outcomes: recovery, transplantation, transition to VAD. Adverse events analyzed per ACTION registry criteria.
Main Results:
- Twenty pediatric subjects (median age 15.6 years) received Impella support after VA-ECMO.
- Common diagnoses included dilated cardiomyopathy/myocarditis (45%) and congenital heart disease (20%).
- Adverse events: hemolysis (50%), bleeding (20%). Mortality was low (10%). 45% recovered, 40% transitioned to VAD, 5% underwent transplantation.
Conclusions:
- Impella percutaneous pump support is a viable strategy in older pediatric patients on peripheral VA-ECMO.
- It effectively facilitates left heart decompression and serves as a bridge to myocardial recovery, durable VAD, or transplantation.
- This approach offers a promising strategy for managing complex pediatric cardiogenic shock.
Abstract:
We report the largest pediatric multicenter experience with Impella pump use and peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support. Utilizing the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) collaborative database, we conducted a retrospective, multicenter study of all patients with cardiogenic shock requiring VA-ECMO support with subsequent Impella implant between October 2014 and December 2021. The primary outcome was defined as death while on Impella support. Secondary outcomes were recovery, transplantation, and transition to durable ventricular assist device (VAD) at the time of Impella explantation. Adverse events were defined according to the ACTION registry criteria. Twenty subjects were supported with Impella; Impella 2.5 (n = 3), CP (n = 12), 5.0/5.5 (n = 5). The median Interquartile range (IQR) age, weight, and body surface area at implantation were 15.6 years (IQR = 13.9-17.2), 65.7 kg (IQR = 53.1-80.7), and 1.74 m2 (IQR = 1.58-1.98). Primary cardiac diagnoses were dilated cardiomyopathy/myocarditis in nine (45%), congenital heart disease in four (20%), graft failure/rejection in four (20%), and three (15%) others. Most common adverse events included hemolysis (50%) and bleeding (20%). There were two deaths (10%) in the cohort. Nine patients (45%) were explanted for recovery, eight (40%) were transitioned to a durable VAD, and one (5%) underwent heart transplantation. Impella percutaneous pump support should be considered in the older pediatric population supported with peripheral VA-ECMO, as a means of left heart decompression, and a strategy to come off ECMO to achieve endpoints of myocardial recovery, transition to a durable VAD, or transplantation.
