ECPella: Concept, Physiology and Clinical Applications

Addition of Impella on top of venoarterial extracorporeal membrane oxygenation (VA-ECMO) has gained wide interest as it might portend improved outcomes in patients with cardiogenic shock. This has been consistently reported in retrospective propensity-matched studies, case series, and meta-analyses. The pathophysiologic background is based on the mitigation of ECMO-related side effects and the additive benefit of myocardial unloading. In this perspective, thorough knowledge of these mechanisms is required to optimize the management of mechanical circulatory support with this approach and introduce best practices, as the interplay between the two devices and the implantation-explantation strategies are key for success. (c) 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Automated summary

The addition of Impella to venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been shown to improve outcomes in patients with cardiogenic shock. This is based on the mitigation of ECMO-related side effects and the additional benefit of myocardial unloading. Thorough understanding of these mechanisms and best practices is crucial for successful management of mechanical circulatory support with this approach.