ECPELLA as a Bridge to Unexpected Myocardial Recovery in a Patient in Refractory Cardiogenic Shock

Cardiogenic shock (CS) is a complex, multifactorial syndrome with substantial morbidity and mortality. Despite neutral results from randomized controlled trials, venoarterial extracorporeal membrane oxygenation (VA-ECMO) may be reasonable for select patients with refractory CS. A 37-year-old woman with morbid obesity and dilated nonischemic cardiomyopathy presented with Society of Cardiovascular Angiography and Intervention stage D biventricular CS, requiring vasopressor support and emergent escalation to ECPELLA, the combination of VA-ECMO and Impella (Abiomed), as a bridge to decision. She was provisionally accepted for a left ventricular assist device as destination therapy; however, her hospital course was complicated by cardiac arrest, recurrent ventricular tachycardia, lung collapse, and progressive renal failure. Planned surgical intervention was deferred as surveillance imaging demonstrated partial native myocardial recovery. The patient was eventually weaned off all support and discharged home. ECPELLA, as compared with VA-ECMO alone, has been associated with improved survival, and this case highlights its potential role as a bridge to myocardial recovery.