Impella 5.0 Therapy Decreases Bleeding Complications in Patients after Change from Extracorporeal Life Support

Objectives: Various options of temporary mechanical circulatory support (tMCS) have shown to improve survival but only little data exist on bleeding complications during the time of tMCS using different devices. All forms of tMCS require anticoagulation and carry a risk of bleeding which has shown to be negatively associated with dismal outcome. The aim of this study was to compare bleeding complications under extracorporeal life support (ECLS) and Impella 5.0 (Abiomed, Danvas) therapy.

Methods: We retrospectively analyzed all 26 patients who underwent veno-arterial ECLS and subsequent change to Impella 5.0 therapy in our institution between March 2016 and August 2018. Eleven patients were excluded from the study because both devices were explanted at the same time or the patient died on tMCS. Anticoagulation protocol was comparable in both groups consisting of aPTT 50 to 60 seconds. We reviewed and compared the number of transfused packed red blood cells (PRBC) during the time of ECMO and Impella 5.0 support.

Results: We included 15 patients who were successfully weaned from ECLS and underwent subsequent Impella 5.0 implantation via the axillary artery without any periprocedural complications. Mean patients age was 57 ± 8.4 years and 12 (80%) patients were male. Acute cardiogenic shock due to ischemic or dilative cardiomyopathy was the main indication for tMCS in 80%. Three other patients (20%) needed ECLS for postcardiotomy failure. Mean duration of ECLS and Impella 5.0 therapy (10.3 ± 5.7 vs. 12.3 ± 5.3 days) did not differ significantly (p = 0.231). The average number of PRBC that were transfused under ECLS was significantly higher than during Impella 5.0 support (30.5 ± 19 vs 13.6 ± 16, p = 0.005). Additionally the PBRC rate per day was significantly reduced from 3.3 to 1.2 PRBC under Impella 5.0 support alone (p-value 0.0007).

Conclusion: The need for blood transfusions is significantly lower in patients under Impella 5.0 therapy compared with patients on extracorporeal life support. To improve outcome and to increase survival rates in these patients, we recommend that ECMO should be replaced by Impella 5.0 as soon as possible, particularly whenever LV support alone is sufficient.