Secondary LV Unloading after Out-of-hospital ECLS Implantation and Transportation Improved Survival and Probability of Successful Weaning

Objective: Extracorporeal life support (ECLS) is an established and recommended treatment modality in patients with acute carcinogenic shock. Safety and feasibility of this technique increased this treatment to out of hospital implantation and transportation. LV unloading in patients on ECLS has shown to increase survival and probability of successful weaning from short-term mechanical circulatory support (MCS). We here present our treatment algorithms and outcomes after ECLS implantation and transportation outside our own center.

Methods: Between October 2014 and March 2017 a total number of 47 consecutive patients (mean age 53 years, range 37 to 74) received an ECLS implantation in a referring institution. Of those 29 (61.7%) received arterial-venous ECLS implantation using a femoral percutaneous approach. Prospective collected data were retrospectively analyzed for survival and weaning depending on LV unloading.

Results: 30day survival in V-A ECLS patients was 51.8%. 9 patients (31%) received an additional Impella 2.5/ CP implantation for LV unloading after a mean time of 7.6 hour and one patient an LA cannula after ECLS implantation and transportation to our center. Survival in patients with LV unloading was higher compared with those without LV unloading (70.0% versus 42.1%, p = 0.02). 50% of LV unloaded patients were able to be weaned from MCS versus 36.8% without additional LV unloading (p = 0.08). Four patients on ECLS and Impella 2.5 support were successfully bridged to a single Impella 5.0 support. Three patients could be weaned from ECLS afterwards, one deceased. Two patients were bridged to a durable assist device.

Conclusion: LV unloading using an Impella 2.5 in patients after a successful implantation of an ECLS in a referring hospital significantly improved survival and weaning from short-term device and is therefore recommended in transported ECLS patients after the arrival in the treatment center.