left ventricular mechanical support with the impella during extracorporeal membrane oxygenation

background: venoarterial extracorporeal membrane oxygenation (ecmo) provides systemic arterial support without directly unloading the left heart, which causes an elevated left ventricular (lv) pressure. the aim of the present study was to investigate the adjunctive application of the impella device for lv unloading in patients during ecmo. methods: this retrospective cohort study included patients who received impella support in addition to venoarterial ecmo between april 2012 and december 2015. ecmo cannulation was performed peripherally or centrally, while the impella device was surgically inserted into the femoral artery or the right axillary artery. results: among 62 patients, 10 (16.1%) received an impella device during ecmo support. following impella support, right atrial pressure improved from a median of 18 (iqr, 14–24) mmhg to 13 (iqr, 10–15) mmhg and pulmonary wedge pressure improved from 30 (iqr, 26–35) mmhg to 16 (iqr, 12–19) mmhg in all the patients (p value < 0.001). follow-up transthoracic echocardiograms (n = 6) showed a median decrease of 0.8 cm in lv end-diastolic volume (p value = 0.021). there were 5 (50%) in-hospital deaths due to sustained brain injury (n = 3) and refractory cardiogenic shock (n = 2). the remaining 5 patients were discharged and successfully bridged to more permanent lv assist device (n = 2) or heart transplantation (n = 3). conclusion: the findings of the present study indicate that the application of the impella device during ecmo support is effective in lv unloading and confers optimal hemodynamic support.