Left Ventricular Unloading With Impella Versus Intra-Aortic Balloon Pump in Cardiogenic Shock Requiring Venoarterial Extracorporeal Membrane Oxygenation.

BACKGROUND

Optimal unloading strategies for patients with cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation remain uncertain, particularly when comparing Impella and intra-aortic balloon pump (IABP). We aimed to compare outcomes of patients receiving Impella or IABP during venoarterial extracorporeal membrane oxygenation and evaluate cause-specific differences.

METHODS

In this retrospective cohort study using the nationwide JROAD-DPC (Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination) database from 2012 to 2023, patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation and either Impella or IABP were analyzed. Propensity score-based inverse probability of treatment weighting was applied to adjust baseline differences.

RESULTS

Among 18 906 patients (Impella, n=1688; IABP, n=17 218), overall in-hospital mortality was 57.3% with Impella and 67.2% with IABP. Impella use was associated with lower in-hospital mortality compared with IABP (odds ratio [OR], 0.86 [95% CI, 0.75-0.99]). Cause-specific analyses showed significantly lower mortality with Impella in heart failure (OR, 0.66 [95% CI, 0.47-0.91]) and arrhythmia (OR, 0.62 [95% CI, 0.42-0.91]). Impella use was also associated with longer hospital stay (median, 22 versus 12 days), longer support duration (7 versus 4 days), and higher total costs (56.1 versus 27.3 thousand USD).

CONCLUSIONS

In this nationwide cohort, Impella unloading during venoarterial extracorporeal membrane oxygenation was associated with lower in-hospital mortality than IABP in the overall cohort, particularly in selected causes, at the expense of prolonged hospitalization and higher costs. Further studies are needed to define optimal cause-specific unloading strategies in cardiogenic shock.