VVECPella: Combined Venovenous ECMO and Impella 5.5 for Cardiopulmonary Failure

Survival with acute cardiopulmonary failure remains a formidable challenge despite advances in mechanical circulatory support (MCS). Although venoarterial extracorporeal membrane oxygenation (ECMO) provides combined cardiopulmonary support, patients with improving cardiac function and persistent respiratory failure may no longer require arterial ECMO. We describe our early experience using a combine venovenous (VV) ECMO and Impella 5.5 (VVECPella) as a de-escalation strategy in this setting. We report a series of five patients supported with the VVECPella configuration at our institution from January 2025 to January 2026. Impella 5.5 was implanted via axillary, innominate, or direct ascending grafts. Operative details, hospital course, and patient outcomes were retrospectively reviewed. In total, five patients underwent VVECPella support. The most common indication was persistent severe respiratory failure despite improving hemodynamics following cardiogenic shock. Median VV ECMO duration was 4 days (range 1-8), Impella support 6 days (3-15), and combined support 4 days (2-8). Four patients (80%) were successfully weaned from both devices with recovery of cardiac and respiratory function, while one patient died from multiorgan failure. Major hemolysis occurred in 3 patients (60%), whereas vascular complications were attributable to prior VA ECMO cannulation rather than the VVECPella configuration. In conclusion, VVECPella appears to be a feasible de-escalation strategy for carefully selected patients with improving circulatory failure but persistent respiratory insufficiency, allowing independent titration of cardiac and respiratory support while avoiding prolonged arterial ECMO. Larger multicenter studies are warranted.