Background: Various options for temporary mechanical circulatory support (tMCS) have shown to improve survival, but little data exist on bleeding complications during the duration tMCS using different devices. All forms of tMCS require anticoagulation and carry a risk of bleeding, which has shown to be associated with a poor outcome.
Hypothesis: The aim of this study was to compare bleeding complications under extracorporeal life support (ECLS) and Impella 5.0 therapy.
Methods: We retrospectively analysed all 26 patients who underwent veno-arterial ECLS and subsequent change to Impella 5.0 therapy in our institution between March 2016 and August 2018. Eleven patients were excluded from the study because both devices were explanted at the same time or the patient died while on tMCS. Anticoagulation protocol was comparable in both groups. We reviewed and
compared the number of transfused packed red blood cells (PRBC) during the time of extracorporeal membrane oxygenation and Impella 5.0 support.
Results: We included 15 patients who were successfully weaned from ECLS and underwent subsequent Impella 5.0 implantation via the axillary artery without any periprocedural complications. The mean patient age was 57 ± 8.4 years and 12 (80%) patients were men. Acute cardiogenic shock due to ischaemic or dilative cardiomyopathy was the main indication for tMCS in 80%. Three other patients (20%) needed ECLS for postcardiotomy failure. The mean duration of ECLS and Impella 5.0 therapy (10.3 ± 5.7 days versus 12.3 ± 5.3 days) did not differ significantly (p=0.231). The average number of PRBC transfused under ECLS was significantly higher than during Impella 5.0 support (30.5 ± 19 versus 13.6 ± 16, p=0.005). Additionally, the PBRC rate per day was significantly reduced with Impella 5.0 support alone, from 3.3 to 1.2 PRBC (p=0.0007).
Conclusion: The need for blood transfusions is significantly lower in patients on Impella 5.0 therapy compared to patients on extracorporeal life support. To improve outcome and to increase survival rates in these patients, we recommend that extracorporeal membrane oxygenation be replaced by Impella 5.0 as soon as possible.