ImpellaCP or VA-ECMO in profound cardiogenic shock: left ventricular unloading and organ perfusion in a large animal model

Ole Kristian Møller-Helgestad, Janus A Hyldebrandt, Ann Banke, Charlotte S Rud, Nanna L J Udesen, Louise Linde, Lisette Okkels-Jensen, Henrik Schmidt, Hanne B Ravn, Jacob E Møller

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Abstract

AIMS: The aim of this study was to evaluate the Impella CP over veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and their impact on left ventricular unloading and end-organ perfusion.

METHODS AND RESULTS: Cardiogenic shock (CS) was induced by injecting microspheres into the left coronary artery in fourteen adult female swine. Impella CP or VA-ECMO was initiated in the presence of CS and evaluated after 60 minutes. Left ventricular pressure-volume area (PVA, total mechanical work) was obtained from a conductance catheter. Results are presented as mean (95% confidence interval) and the rank-sum test was used to assess differences between devices. Compared to the CS state, PVA was unaffected by Impella CP and increased on VA-ECMO (from 2,548 [2,193; 2,904] mmHg x mL during CS to 5,775 [4,451; 7,099], between device p-value=0.02). Arterial lactate increased during CS and decreased on support with no difference between devices. Renal venous oxygen saturation decreased during CS and increased on support with no difference between devices. Cerebral venous oxygen saturation increased to 33% [25, 40] on Impella CP and to 69% [49, 89] on VA-ECMO, p=0.04.

CONCLUSIONS: In this porcine model of profound CS, Impella CP unloaded the left ventricle compared to VA-ECMO. Both devices improved end-organ perfusion, with a tendency towards higher venous oxygen saturations on VA-ECMO.

Original languageEnglish
JournalEuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
Volume14
Issue number15
Pages (from-to)e1585-e1592
ISSN1774-024X
DOIs
Publication statusPublished - 8. Feb 2019

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Extracorporeal Membrane Oxygenation
Cardiogenic Shock
Perfusion
Equipment and Supplies
Oxygen
Ventricular Pressure
Nonparametric Statistics
Microspheres
Heart Ventricles
Lactic Acid
Catheters
Confidence Intervals
Kidney

Cite this

@article{0b51c46db8d4470b8960543f251be091,
title = "ImpellaCP or VA-ECMO in profound cardiogenic shock: left ventricular unloading and organ perfusion in a large animal model",
abstract = "AIMS: The aim of this study was to evaluate the Impella CP over veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and their impact on left ventricular unloading and end-organ perfusion.METHODS AND RESULTS: Cardiogenic shock (CS) was induced by injecting microspheres into the left coronary artery in fourteen adult female swine. Impella CP or VA-ECMO was initiated in the presence of CS and evaluated after 60 minutes. Left ventricular pressure-volume area (PVA, total mechanical work) was obtained from a conductance catheter. Results are presented as mean (95{\%} confidence interval) and the rank-sum test was used to assess differences between devices. Compared to the CS state, PVA was unaffected by Impella CP and increased on VA-ECMO (from 2,548 [2,193; 2,904] mmHg x mL during CS to 5,775 [4,451; 7,099], between device p-value=0.02). Arterial lactate increased during CS and decreased on support with no difference between devices. Renal venous oxygen saturation decreased during CS and increased on support with no difference between devices. Cerebral venous oxygen saturation increased to 33{\%} [25, 40] on Impella CP and to 69{\%} [49, 89] on VA-ECMO, p=0.04.CONCLUSIONS: In this porcine model of profound CS, Impella CP unloaded the left ventricle compared to VA-ECMO. Both devices improved end-organ perfusion, with a tendency towards higher venous oxygen saturations on VA-ECMO.",
author = "M{\o}ller-Helgestad, {Ole Kristian} and Hyldebrandt, {Janus A} and Ann Banke and Rud, {Charlotte S} and Udesen, {Nanna L J} and Louise Linde and Lisette Okkels-Jensen and Henrik Schmidt and Ravn, {Hanne B} and M{\o}ller, {Jacob E}",
year = "2019",
month = "2",
day = "8",
doi = "10.4244/EIJ-D-18-00684",
language = "English",
volume = "14",
pages = "e1585--e1592",
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publisher = "Europa Digital & Publishing",
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}

TY - JOUR

T1 - ImpellaCP or VA-ECMO in profound cardiogenic shock

T2 - left ventricular unloading and organ perfusion in a large animal model

AU - Møller-Helgestad, Ole Kristian

AU - Hyldebrandt, Janus A

AU - Banke, Ann

AU - Rud, Charlotte S

AU - Udesen, Nanna L J

AU - Linde, Louise

AU - Okkels-Jensen, Lisette

AU - Schmidt, Henrik

AU - Ravn, Hanne B

AU - Møller, Jacob E

PY - 2019/2/8

Y1 - 2019/2/8

N2 - AIMS: The aim of this study was to evaluate the Impella CP over veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and their impact on left ventricular unloading and end-organ perfusion.METHODS AND RESULTS: Cardiogenic shock (CS) was induced by injecting microspheres into the left coronary artery in fourteen adult female swine. Impella CP or VA-ECMO was initiated in the presence of CS and evaluated after 60 minutes. Left ventricular pressure-volume area (PVA, total mechanical work) was obtained from a conductance catheter. Results are presented as mean (95% confidence interval) and the rank-sum test was used to assess differences between devices. Compared to the CS state, PVA was unaffected by Impella CP and increased on VA-ECMO (from 2,548 [2,193; 2,904] mmHg x mL during CS to 5,775 [4,451; 7,099], between device p-value=0.02). Arterial lactate increased during CS and decreased on support with no difference between devices. Renal venous oxygen saturation decreased during CS and increased on support with no difference between devices. Cerebral venous oxygen saturation increased to 33% [25, 40] on Impella CP and to 69% [49, 89] on VA-ECMO, p=0.04.CONCLUSIONS: In this porcine model of profound CS, Impella CP unloaded the left ventricle compared to VA-ECMO. Both devices improved end-organ perfusion, with a tendency towards higher venous oxygen saturations on VA-ECMO.

AB - AIMS: The aim of this study was to evaluate the Impella CP over veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and their impact on left ventricular unloading and end-organ perfusion.METHODS AND RESULTS: Cardiogenic shock (CS) was induced by injecting microspheres into the left coronary artery in fourteen adult female swine. Impella CP or VA-ECMO was initiated in the presence of CS and evaluated after 60 minutes. Left ventricular pressure-volume area (PVA, total mechanical work) was obtained from a conductance catheter. Results are presented as mean (95% confidence interval) and the rank-sum test was used to assess differences between devices. Compared to the CS state, PVA was unaffected by Impella CP and increased on VA-ECMO (from 2,548 [2,193; 2,904] mmHg x mL during CS to 5,775 [4,451; 7,099], between device p-value=0.02). Arterial lactate increased during CS and decreased on support with no difference between devices. Renal venous oxygen saturation decreased during CS and increased on support with no difference between devices. Cerebral venous oxygen saturation increased to 33% [25, 40] on Impella CP and to 69% [49, 89] on VA-ECMO, p=0.04.CONCLUSIONS: In this porcine model of profound CS, Impella CP unloaded the left ventricle compared to VA-ECMO. Both devices improved end-organ perfusion, with a tendency towards higher venous oxygen saturations on VA-ECMO.

U2 - 10.4244/EIJ-D-18-00684

DO - 10.4244/EIJ-D-18-00684

M3 - Journal article

C2 - 30418160

VL - 14

SP - e1585-e1592

JO - EuroIntervention

JF - EuroIntervention

SN - 1774-024X

IS - 15

ER -