ECPella 5+ in Patients With Cardiogenic Shock: Potential for Improved Outcomes

The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for temporary mechanical circulatory support (MCS) is a common treatment in patients with cardiogenic shock (CS) but is associated with high morbidity and mortality. The combination therapy of VA- ECMO and Impella (ECPella) results in better outcomes. Currently, multiple generations of Impella are available for use in ECPella, however limited data exist to compare devices. Here, we explored whether ECPella 5+ adds further benefit to patient outcomes. We reviewed published studies focused on ECPella in CS to summarize clinical outcomes specifically pertaining to ECPella 5+. Findings were compared to outcomes from a contemporary cohort of 10 patients admitted for cardiogenic shock and treated with ECPella 5+ between January 2022 and May 2023. We evaluated 84 studies published in Pubmed between January 2017 and October 2023. Of these, 24 articles were selected for full analysis. Use of ECPella 5+ increased over time, with more than 50% of patients receiving this configuration in studies published in 2023. Mortality rate for ECPella 5+ (reported in 5 of 24 studies) was 33% compared to 49% for all ECPella combinations. Mortality outcomes of our patient cohort were consistent with a rate of 30%. These findings suggest that Impella 5+ may further improve outcomes of ECPella. However, the interpretation is limited by the small sample size and the descriptive nature of the data. Further larger, prospective studies are needed to determine potential improvements in complication rates, VA-ECMO and inotropic therapy duration, and native heart recovery.