Early MCS with Impella® and V-A ECMO in Refractory Cardiogenic Shock

Jörn Tongers, MD, discusses his recently published paper evaluating the efficacy and safety of early combined mechanical circulatory support (MCS) with an Impella® heart pump and venoarterial extracorporeal membrane oxygenation (V-A ECMO) in patients with refractory cardiogenic shock. Dr. Tongers is an attending interventional cardiologist and intensivist at Halle University Hospital in Germany.

Emphasizing the difficulty of treating refractory cardiogenic shock and the lack of current guidelines, Dr. Tongers explains that this paper sought to address questions such as how to proceed after stabilizing patients, how to wean or discontinue MCS therapy and in which order.

This single-center, observational study, conducted at a tertiary university center in northwestern Germany, focused on treating patients with cardiogenic shock who were refractory to gold standard therapy. Dr. Tongers describes the patients in the study as profoundly ill by hemodynamic parameters with two-thirds of the patients having biventricular failure (in an era before Impella RP®). He explains that depending on the primary issues and the experience of the referral center, some patients were treated with V-A ECMO first and then Impella, while others received Impella first, and then V-A ECMO.