Effectiveness of an Impella versus intra-aortic balloon pump in patients who received extracorporeal membrane oxygenation

Abstract

AbstractBackgroundPrevious studies have suggested that left ventricular (LV) unloading with an intra-aortic balloon pump (IABP) or percutaneous ventricular assist device (Impella) in combination with extracorporeal membrane oxygenation (ECMO) is associated with lower mortality; however, it is unclear which is better. This study aimed to evaluate the effectiveness of LV unloading with an Impella versus IABP on in-hospital mortality and other clinical outcomes.MethodsUsing the Japanese Diagnosis Procedure Combination database from September 28, 2016, to March 31, 2022, we identified inpatients who received an Impella or IABP in combination with ECMO (ECPella or ECMO+IABP group, respectively). The primary outcome was in-hospital mortality and the secondary outcomes were the length of hospital stay, length of ECMO, total hospitalization cost, and complications. Propensity score matching was performed to compare the outcomes between the groups.ResultsOf 14,525 eligible patients, 603 (4.2%) received ECPella and 13,922 (96%) received ECMO+IABP. After propensity score matching, there was no significant difference in in-hospital mortality between the two groups (58.9% versus 56.6%; risk difference, 2.3%; 95% confidence interval, −3.9% to 8.5%). The ECPella group had a longer hospital stay, higher total hospitalization cost, and more frequent major bleeding, vascular complications, and renal replacement therapy during hospitalization than the ECMO+IABP group.ConclusionsThis nationwide inpatient database study showed that ECPella was not associated with a survival benefit but was associated with a longer hospital stay, higher total hospitalization cost, and more complications than ECMO+IABP.