Benefit of veno-arterial extracorporeal membrane oxygenation combined with Impella (ECpella) therapy in acute coronary syndrome with cardiogenic shock

Patients with acute coronary syndrome complicated with cardiogenic shock (ACS-CS) frequently require mechanical circulatory support. In addition to veno-arterial extracorporeal membrane oxygenation (VA-ECMO), use of the Impella® (ECpella) (Abiomed Inc., Danvers, MA, USA) heart pump may improve the prognosis of such patients. In this study, we compared the efficacy of VA-ECMO plus intra-aortic balloon pumping (ECMO-IABP) with that of the ECpella for add-on circulatory support of VA-ECMO. Clinical outcomes of 64 patients with ACS-CS treated with ECMO-IABP (n = 41) or ECpella (n = 23) between January 2013 and April 2021 were retrospectively analyzed. The primary outcomes were 30-day and 365-day mortality. In addition, patients resuscitated after cardiopulmonary arrest (CPA) were evaluated separately. The ECpella group showed significantly lower mid-term mortality than the ECMO-IABP group [30-day mortality (39.1% vs 56.1%, respectively; p = 0.193) and 365-day mortality (43.5% vs 75.6%, respectively; p = 0.010)], with significantly higher rates of new hemodialysis and bleeding at the vascular access site. Also, among the limited number of patients resuscitated from CPA, mortality was significantly lower in the ECpella group than the ECMO-IABP group [30-day mortality (28.6% vs 65.4%, respectively; p = 0.026) and 365-day mortality (28.6% vs 84.6%, respectively; p