Clinical Associations of Successful Weaning from Impella Support in Non-ischemic Cardiogenic Shock

Background The efficacy of Impella in ischemic cardiogenic shock (CS) has been examined. This study evaluated the Impella clinical course in non-ischemic CS and examined the differences in 72-h factors after Impella implantation between successful and unsuccessful weaning. Methods This observational, retrospective, single-center cohort study included 43 patients with non-ischemic CS [fulminant myocarditis (n=25) and HF-related CS (n=18)] from July 2018 to July 2022. The background, clinical course, and clinical predictors of successful weaning were evaluated in this study. Results The median age was 45 (31-53) years; 37% (n=16) were women, 79% (n=34) were on concomitant veno-arterial extracorporeal membrane oxygenation. duration of Impella use was 11 (6-20) days; 14% (n=6) had severe bleeding, 26% (n=11) had bacteremia complications, and 53% (n=24) required new temporary dialysis. The 30-day unsuccessful Impella weaning rates for HF-related CS and fulminant myocarditis were 36% and 33%; the 365-day rates were 48% and 67%, respectively. Regarding the factors between successful and unsuccessful Impella weaning, left ventricular ejection fraction and serum lactate dehydrogenase levels significantly differed 72 h after Impella implantation in fulminant myocarditis and with systolic blood pressure in HF-related CS. Conclusion In non-ischemic CS cases requiring Impella, successful weaning rates vary greatly depending on the underlying disease, and the factor at 72h after Impella insertion are associated with the subsequent course.