Acute cardiac care & resuscitation
Left-ventricular unloading in extracorporeal cardiopulmonary resuscitation due to acute myocardial infarction – A multicenter study
Main finding · 30-day mortalityResult — go to the resultHazard ratio 0.53 95% CI 0.31–0.91Authors' conclusion
LV unloading with Impella® concomitant to VA-ECMO therapy in patients with therapy-refractory cardiac arrest due to AMI was associated with improved patient outcomes.
Study context
- Population
- Adults with refractory cardiac arrest caused by acute myocardial infarction (AMI) treated with extracorporeal CPR, 3 centres, 2016–2021
- Participants
- 95 adults · 34 matched pairs
- Exposure
- ECMELLA vs veno-arterial extracorporeal membrane oxygenation (VA-ECMO) alone
- Outcome
- 30-day mortality
- Follow-up
- 30 days
Methodological detailspropensity-score matched, multicentre (3 centres)
- Propensity-score matched
- Multicentre (3 centres)
Main finding
As reported in the abstract
Hazard ratio
0.53
95% CI 0.31–0.91
P = 0.021
ECMELLA vs VA-ECMO
HR 0.53 (95% CI 0.31–0.91); P = 0.021
Observational data: associations, not effects.
Secondary outcomes
| Outcome | IRR (95% CI) | P value | |
|---|---|---|---|
| Hospital length of stayProlonged with ECMELLA | 1.71 (1.50–1.95) | P < 0.001 | |
| ICU length of stayProlonged with ECMELLA | 1.81 (1.57–2.08) | P < 0.001 | |
| 0.512Incidence rate ratio (log scale) |
LVEF · until intensive care unit (ICU) discharge
- LVEF significantly improved until ICU discharge in the ECMELLA group
Subgroups: prolonged low-flow time, high initial lactate
- Patients with prolonged low-flow time and high initial lactate especially benefited from additional left-ventricular (LV) unloading
Original publication
Left-ventricular unloading in extracorporeal cardiopulmonary resuscitation due to acute myocardial infarction – A multicenter study. Resuscitation. Published 21 March 2023. doi:10.
Summarised from the published abstract; every number is checked against it