Algorithms, ECMO, AMI Cardiogenic Shock, Surgical Applications

85% Survival with Impella 5.5® with SmartAssist® Heart Pump ECpella


Alan Gass, MD, discusses data he has published on the use of Impella 5.5® with SmartAssist® heart pump in patients with SCAI Stages D and E cardiogenic shock. He explains that in the past his center has done 50-100 ECMO procedures each year but Impella 5.5 with SmartAssist heart pump has led to “a huge paradigm shift.”

The first paper he discusses—"High flow from Impella 5.5 [with SmartAssist heart pump] with partial veno-arterial extracorporeal membrane oxygenation support: Case series”—followed 7 patients treated with upfront Impella 5.5 with SmartAssist device support plus ECMO. He refers to this paper as “almost like a proof of concept.” In these 7 ECpella patients survival was 71.4% with native heart recovery in 5 patients, 1 transplant, and 2 deaths (1 on support and 1 weeks later).

The second paper—"ECpella 5.5: An evolution in the management of mechanical circulatory support”—illustrates a new approach to ECpella at his institution. Dr. Gass explains that patients used to have 4-5 days of ECMO support with the ECpella strategy before ECMO weaning. “Now that we put the [Impella 5.5 with SmartAssist heart pump] in along with ECMO,” Dr. Gass states, “we’re getting the ECMO out within 2 days.” This, he explains, helps avoid the ever-present risks associated with ECMO.

Dr. Gass shows a flowchart with his new treatment strategy for SCAI Stage D/E shock, which no longer goes straight to ECMO support. “When I reviewed all of our 600 ECMO patients,” he explains, “about 70% of the patients that went on ECMO could have had a[n] [Impella 5.5 with SmartAssist heart pump] alone.” Thus, he now goes to Impella 5.5 first in a patient in SCAI stage D/E shock with LV failure. If they have pulmonary edema or biventricular failure, he goes to ECpella with Impella 5.5 and then rapidly weans from ECMO to Impella 5.5 support alone.

Dr. Gass highlights what he calls “5.5. First” in which patients with AMI with severe LV dysfunction, AMI with acute mitral regurgitation, ischemic cardiomyopathy with acute decompensated heart failure (ADHF), and postcardiotomy syndrome (PCS) are treated first with Impella 5.5 with SmartAssist heart pump. Data from the use of this strategy in 26 patients reveal 85% survival with 46% of patients experiencing native heart recovery, 31% receiving a heart transplant, and 8% going on to durable LVAD.

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