Nurse Practitioner Nashville, Tennessee, United States
Disclosure(s):
Ashley Bernard, DNP, AGACNP-BC: No financial relationships to disclose
Background: Recent studies have shown microaxial flow pumps improve mortality in patients with acute myocardial infarction-cardiogenic shock (AMI-CS). However, for VA-ECMO the data is mixed and mortality remains high. Data on placement of microaxial flow pumps to facilitate VA-ECMO weaning and cardiac recovery is limited.
Methods: A retrospective review of single center data for patients with SCAI Stage E cardiogenic shock treated with VA-ECMO plus an Impella 5.5 from January 2024 through June 2025, focusing on those with cardiac recovery. Descriptive statistics were used to identify patient characteristics and outcomes.
Outcome: A total of 29 patients were identified, average age 56.2 years, and 23 were male. Survival to discharge occurred in 55.1% (16/29): 2 bridged to transplant, 3 to durable ventricular assist device, and 11 to cardiac recovery. Patients with cardiac recovery were all male with an average age of 53. In this cohort, the main CS phenotype was AMI-CS (n=8), six of whom had suffered cardiac arrest. The average time to Impella 5.5 placement was on ECMO day 3 (range 1-10). Average duration of ECMO and Impella 5.5 support lasted 5.8 and 13.2 days, respectively, with an average hospital length of stay being 29 days. Four patients required renal replacement therapy, one suffered severe bleeding, one required lower limb fasciotomy, and one suffered acute ischemic stroke. Discharge destinations were long term acute care (n=3) and home (n=8). Of the nine patients who maintained follow up, all survived at least sixty days after discharge.
Conclusion: The addition of Impella 5.5 microaxial flow pump may be a viable strategy for weaning VA ECMO and bridging to cardiac recovery in patients with severe AMI-CS.
