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Master Thesis

Impact pronostique de l’association de la pompe IMPELLA® à l’ExtraCorporeal Life Support dans le choc cardiogénique de l’adulte : étude rétrospective monocentrique

Abstract : Introduction. Extracorporeal Life Support (ECLS) is a mechanical circulatory support (MCS) indicated in refractory cardiogenic shock, effective in restoring adequate perfusion of the organs but which increases, by its retrograde arterial reinjection, the afterload of the left ventricle (LV), from which it can compromise myocardial recovery. IMPELLA® is a MCS whose reinjection respects the anterograde direction of the flow generated by the native heart, thus achieving a true discharge of the LV. Our objective was to study the prognostic impact of the ECLS-IMPELLA® combination in the patient in refractory cardiogenic shock, taking into account the temporality of the implantation of two mechanical circulatory support. Materials and methods. This is a retrospective cohort study conducted from January 2011 to June 2018 and included patients supported with ECLS alone or in combination with IMPELLA® 2.5, CP, or 5.0 (ECMELLA), for medically-induced refractory cardiogenic shock only. The primary endpoint was Intensive Care Unit (ICU) mortality. Secondary endpoints were the percentage of patients weaned from MCS, complications on MCS, use of artificial heart, support duration, length stay in ICU and hospital, and mortality at 6 months. Results. During this period, 140 adult patients were included. Eighty-two (58.6%) patients benefited from ECLS alone, 58 (41.4%) from ECMELLA, including 30 with simultaneous implantation of the two MCS and 28 with sequential implantation. No significant difference was observed in ICU mortality between patients receiving ECLS alone and those receiving ECMELLA (35.4% versus 39.7%, p=0.61), as well as mortality at 6 months (39.1% versus 50.9%, p=0.169). Patients on sequential ECMELLA were more rarely discharged alive and weaned from MCS, and were more often implanted with a Left Ventricular Assist Device (LVAD) than patients on ECLS alone or simultaneous ECMELLA. No significant differences were found in MCS-related complications. Conclusion. The ECLS-IMPELLA® combination is a probably interesting MCS strategy in patients in refractory cardiogenic shock who are potential candidates for LVAD. Simultaneous implantation of the devices could in some cases increase the potential for myocardial recovery.
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Submitted on : Wednesday, October 21, 2020 - 6:01:05 PM
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Thomas Gouttenegre. Impact pronostique de l’association de la pompe IMPELLA® à l’ExtraCorporeal Life Support dans le choc cardiogénique de l’adulte : étude rétrospective monocentrique. Sciences du Vivant [q-bio]. 2020. ⟨dumas-02974402⟩

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