Impella Placement Guided by Echocardiography Can Be Used as a Strategy to Unload the Left Ventricle During Peripheral Venoarterial Extracorporeal Membrane Oxygenation
Impella Placement Guided by Echocardiography Can Be Used as a Strategy to Unload the Left Ventricle During Peripheral Venoarterial Extracorporeal Membrane Oxygenation
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DOI：
10.1053/j.jvca.2018.05.019
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发表时间：
2018-12-01
影响因子：
2.8
通讯作者：
Cudemus, Gaston
中科院分区：
文献类型：
--
作者：
Fiedler, Amy G.;Dalia, Adam;Cudemus, Gaston
目的：在作者所在机构，2015年之前，接受外周静脉动脉体外膜氧合（VA-ECMO）插管的患者未使用左室（LV）通气进行左室（LV）减压。2015年后，作者所在的机构开始使用Impella设备对VA-ECMO患者的左心室进行通气。作者假设使用Impella进行左室通气的VA-ECMO患者的生存结果会得到改善。设计：回顾性、基于图表的回顾研究。环境：单中心，校级医院。参与者：2015年1月至2017年5月期间在作者所在机构接受VA-ECMO的所有成年患者。干预措施：将Impella （Abiomed, Danvers， MA）装置经皮放置于插管进行VA-ECMO的患者中，作为提供左室通气和减压的机制，从而卸载心脏。测量和主要结果：进行手工图表回顾，并进行生存分析。我们观察到，与单独维持VA-ECMO的患者相比，超声心动图显示，植入Impella的VA-ECMO患者生存率提高，左室功能改善。结论：与单独接受VA-ECMO治疗的患者相比，VA-ECMO联合Impella植入的患者生存率更高。关键的超声心动图特征，如Impella放置后左室功能的改善和治疗期间左室腔大小的缩小，可以帮助预测哪些患者可能从这种插管策略中获益最多。(C) 2018爱思唯尔公司版权所有。
Objective: At the authors' institution, before 2015, patients cannulated for peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) did not undergo left ventricular (LV) decompression with the use of an LV vent. After 2015, the authors' institution began using the Impella device to vent the left ventricle in patients on VA-ECMO. The authors hypothesized that survival outcomes would improve in patients on VA-ECMO with the use of an Impella for LV venting.Design: Retrospective, chart based review study.Setting: Single center, university-based hospital.Participants: All adult patients at the authors' institution who required VA-ECMO between January 2015 and May 2017.Intervention: An Impella (Abiomed, Danvers, MA) device was placed percutaneously in patients cannulated for VA-ECMO as a mechanism to provide LV venting and decompression, therefore unloading the heart.Measurements and Main Results: Manual chart review was conducted, and a survival analysis was performed. It was observed that patients on VA-ECMO in whom an Impella was implanted had improved survival and an improvement in LV function as demonstrated by echocardiography compared with patients maintained on VA-ECMO alone.Conclusions: Patients on VA-ECMO plus Impella implantation demonstrated improved survival compared with patients treated with VA-ECMO alone. Key echocardiographic characteristics such as improved LV function after Impella placement and LV cavity size reduction during therapy may help predict those patients who may benefit most from this cannulation strategy. (C) 2018 Elsevier Inc. All rights reserved.