Titolo della tesi: ECMO alone versus ECPELLA in patients affected by cardiogenic shock: the multicenter EVACS study.
Objectives:
To investigate the outcomes of concomitant veno-arterial extracorporeal membrane oxygenation (ECMO) and left ventricular unloading with Impella (ECPELLA) compared to ECMO alone to treat patients affected by cardiogenic shock.
Methods:
Data from patients needing mechanical circulatory support from 4 international centers were analyzed. The cohort was divided into two groups: patients treated with veno-arterial ECMO alone and patients treated with ECPELLA.
Results:
Of 438 patients included, ECMO alone and ECPELLA were adopted in 319 (72.8 %) and 119 (27.2 %) patients, respectively. Propensity score matching analysis identified 95 pairs. In the matched cohort, 30-day mortality rates in the ECMO and ECPELLA were 49.5% and 43.2% (P=0.467). The incidences of complications did not differ significantly between groups (P=0.877, P=0.629, P=1.000, respectively). After a median follow-up of 0.18 years (interquartile range 0.02-2.55), the use of ECPELLA was associated with a non-significant trend towards lower mortality compared to ECMO alone (hazard ratio 0.81, 95% confidence interval 0.54-1.20, P=0.285), with 1-year overall survival rates of 51.3 % and 46.6%, for ECPELLA and ECMO alone, respectively.
Conclusion:
ECMO alone and ECPELLA are both effective strategies in patients needing mechanical circulatory support for cardiogenic shock. Nevertheless, left ventricular venting with Impella on top of ECMO represents a promising approach that should be considered to better support the patient’s recovery.