209: Single Arterial Access for ECMO and Impella Support - SAECPELLA

Background: The application of temporary mechanical circulatory support (TMCS) for cardiogenic shock (CS) continues to evolve with increasing recognition of the value of left ventricular venting. Dual application of Impella 5.5 and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides the most robust platform for patients with severe CS. Single axillary arterial access is intended to facilitate rehabilitation of patients receiving dual TMCS. Methods: Description of surgical strategy and technical pitfalls. Retrospective chart review of CS patients receiving dual tMCS with single axillary arterial access for Impella 5.5 and VA-ECMO (SAECPELLA), including management strategies, clinical trajectory, requirement of heart replacement, development of major complications, and hospital survival. Results: A total of 5 patients presenting CS received SAECPELLA support. All patients were male, with a mean age of 58.6±5.9-years. Table 1 summarizes all general demographics and clinical characteristics, and Table 2 summarizes SAECPELLA characteristics and clinical trajectory of patients. Hospital survival was 80% (4 patients) with 1 patient weaned-off support due to myocardial recovery (N=1) and 3 patients bridged to heart transplant. Figure 1 summarizes the trajectory of patients with CS supported with ECPELLA. Following support, a significant difference was observed on ejection fraction (p=0.0076) and fibrinogen levels (p=0.0001). Two device-related complications were reported, and a single mortality occurred while on-support. Conclusions: SAECPELLA configuration is a feasible approach for tMCS in patients with CS, providing promising outcomes via a robust preemptive intervention in face of biventricular failure. Further studies are needed to determine the long-term outcomes of the implementation of this technique.