HAL will be down for maintenance from Friday, June 10 at 4pm through Monday, June 13 at 9am. More information
Skip to Main content Skip to Navigation
Master Thesis

Score prédictif de survie des candidats à l’Impella chez les patients INTERMACS 1 en vue d’un sevrage d’ECMO-VA

Abstract : Veno-arterial extracorporeal life support (VA-ECLS) followed by early weaning with Impella 5.0 is the treatment of choice in INTERMACS 1 patients with refractory and durable cardiogenic shock. We describe a simple metabolic score identifying good candidates for the bridge from VA-ECMO to Impella 5.0. Forty-one consecutive INTERMACS 1 patients with VA-ECMO, who underwent prospective multiparametric measurements right before Impella 5.0 implantation, were followed-up for 30 days. Impella 5.0 was used for weaning VA-ECMO by unloading the LV 30.2 hours following VA-ECMO implantation. Of these, 25 died 6±6 days after Impella 5.0 implantation. They were older (53±12 vs. 43±12 years old, p=0.01) with acute coronary syndrome as primary etiology (64% vs 13%, p=0.0007) of VA-ECMO implantation. In univariate analysis, patients who died exhibited a lower mean arterial pressure (74±17 vs. 89±9 mm Hg, p=0.01), a higher increase in troponin (24000±38000 vs. 3500±5000 UI, p=0.048), a higher serum lactate (8.3±7.4 vs 4.2± 3.8 mmol/l, p=0.05) and had more frequently a cardiac arrest at admission (80% vs. 25%, p=0.03). By multivariate Cox regression analysis, independent predictors of death events were as follows: an increase in serum lactate concentration >7.9 mmol/l (p=0.008) and an increase in troponin>2700 UI (p=0.028). When patients were grouped as having 0, 1 or 2 high-risk predictors of death, mortality rate was 29%, 75% and 100% in less than 30 days, respectively (Log rank, p=0.0001). Both serum lactate and troponin could be useful to identify a high-risk subset of INTERMACS 1 patients under VA-ECMO, awaiting Impella 5.0 implantation as bridge for weaning.
Document type :
Master Thesis
Complete list of metadata

Contributor : Ufr Santé Unicaen Connect in order to contact the contributor
Submitted on : Thursday, January 27, 2022 - 6:28:44 PM
Last modification on : Wednesday, February 23, 2022 - 3:28:25 AM


DOVONOU Estelle.pdf
Files produced by the author(s)


  • HAL Id : dumas-03546208, version 1


Estelle Dovonou. Score prédictif de survie des candidats à l’Impella chez les patients INTERMACS 1 en vue d’un sevrage d’ECMO-VA. Médecine humaine et pathologie. 2021. ⟨dumas-03546208⟩



Record views


Files downloads