Optimizing Heart Recovery with Impella 5.5^™ with SmartAssist^™ and VA-ECMO

In some high-risk cardiogenic shock patients, venoarterial extracorporeal membrane oxygenation (VA- ECMO) alone may not be enough. Studies have shown that combining Impella 5.5^TM with SmartAssist^TM with VA-ECMO in select patients can improve survival as well as help optimize weaning strategies and heart recovery.

Peripheral VA-ECMO alone loads the left ventricle (LV) due to retrograde perfusion. This can significantly increase LV afterload and prevent the aortic valve from opening, leading to LV impairment. Due to volume overload, LV filling pressures and wall stress increase and can lead to pulmonary congestion and potential thrombus formation. As the degree of LV distension increases, myocardial recovery is inhibited, leading to a decrease in survival. In patients with LV failure on ECMO, the pressure-volume (PV) loop shifts to the right as ECMO increases end-diastolic pressure and effective arterial elastance and decreases left ventricular stroke volume.

Adding Impella 5.5 with SmartAssist to VA-ECMO provides full left ventricular support and can help unload the left ventricle. Initiating Impella support within 2 hours of ECMO has been shown to reduce short-term mortality. The addition of Impella 5.5 with SmartAssist reduces end-diastolic pressure and volume and thus the workload of the heart. The PV loop triangulates to the left with continuous flow across the aortic valve.

The most recent data from the Extracorporeal Life Support Organization (ELSO) shows that the median duration of VA-ECMO support is five days. Adding Impella 5.5 with SmartAssist to VA-ECMO has been shown to significantly reduce the number of days on ECMO support. Patients can be weaned from ECMO while maintaining full LV support with Impella 5.5 with SmartAssist. In addition, after successfully weaning off ECMO, the patient supported with Impella 5.5 with SmartAssist is able to sit upright and begin ambulation, further optimizing heart recovery.