Elsevier

Resuscitation

Volume 112, March 2017, Pages 70-74
Resuscitation

Short communication
The Impella CP device for acute mechanical circulatory support in refractory cardiac arrest

https://doi.org/10.1016/j.resuscitation.2016.10.003Get rights and content

Abstract

Introduction

Mechanical circulatory support may be considered as a therapeutic option in selected patients with refractory cardiac arrest (rCA). Animal studies suggest a potential role for the Impella® left ventricular assist device in this setting, but so far no human data have been published.

Methods

Eight patients with rCA were treated with the Impella CP® device at our institution from November 2014 to October 2015. The Impella CP® was used at the discretion of the treating physicians in patients with rCA and pulseless electrical activity with presumed primary left ventricular failure. These patients were compared to 12 patients with cardiogenic shock also treated with the Impella device during the same period.

Results

All cardiac arrests were witnessed with a no-flow time of 0 min, six in-hospital and two out-of-hospital. Low-flow time was 50 ± 52 min (SD). The Impella device was successfully inserted in all patients with rCA and circulation was re-established. Survival rate to hospital discharge with good neurological outcome was similar among patients with rCA and cardiogenic shock treated with the Impella device (50% vs. 58%). Major vascular complications after Impella insertion occurred more frequently among patients with rCA compared to patients with cardiogenic shock (50% vs. 0%, P < 0.05).

Conclusion

Mechanical support with the Impella CP® device is a feasible and promising treatment option for selected patients with rCA. Further studies are warranted to determine the full potential and optimal patient selection compared to other modalities of mechanical circulatory support.

Introduction

Despite improvements in cardiopulmonary resuscitation (CPR) procedures refractory cardiac arrest (rCA) remains associated with very high mortality rates. Mechanical circulatory support with Veno-Arterial Extra Corporal Membrane Oxygenation (VA-ECMO) is considered a promising treatment for patients with rCA.1

VA-ECMO support in rCA patients is; however, associated with a number of complications including cannulation related complications and uncontrolled bleeding.2 Also, VA-ECMO does not reduce left ventricular (LV) afterload and wall stress which may adversely reduce LV recovery.3

The left ventricular assist device Impella CP® propels blood from the LV cavity into the ascending aorta with continuous non-pulsatile flow thereby reducing left ventricular volume and walls stress. In a porcine model of cardiac arrest the Impella® device led to doubled rates of return of spontaneous circulation and a better cardiac functional outcome in the early post-arrest period.4

There is to our knowledge no human data on the effect of mechanical support with the Impella device in patients with rCA.

We here report our first experiences and results with the Impella CP® device in selected patients with rCA.

Section snippets

Methods

This report comprises a dual case series of all patients with rCA (N = 8) and cardiogenic shock (N = 12) treated with the Impella® device (Abiomed, Inc., Danvers, MA, USA) at Aarhus University Hospital, Denmark from November 2014 to October 2015.

The Impella CP® was used at the discretion of the treating physicians in patients with rCA and pulseless electrical activity (PEA) with presumed primary left ventricular failure. Patients were either already in or transferred to the Cath. Lab. under

Results

Patient and procedural characteristics are shown in Table 1.

The Impella device was successfully inserted in all patients.

Individual patient peri-arrest characteristics are displayed in Table 2. All arrests were witnessed and manual CPR was initiated immediately. Although several patients achieved brief intermittent ROSC, all patients had had PEA for more than 10 min at the time of Impella insertion. Peri-arrest arterial pH and plasma lactate were 7.02 ± 0.11 and 12 ± 4 mmol/L respectively. All

Discussion

This paper comprises our experiences and results with mechanical circulatory support with the Impella CP® device in selected patients with rCA. This is to our knowledge the first report of using the Impella device in this clinical setting. Circulation was restored in all patients leading to a 50% survival with a good neurological outcome. Vascular complications were; however, more frequent compared with the use of Impella in patients with cardiogenic shock.

VA-ECMO is considered a promising

Conclusion

Mechanical support with the Impella CP® device is a feasible and promising treatment option for selected patients with rCA. Further studies are warranted to determine the full potential and optimal patient selection compared to other modalities of mechanical circulatory support.

Conflict of interest statement

We declare no conflicts of interest.

References (12)

There are more references available in the full text version of this article.

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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2016.10.003.

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