• J. Cardiothorac. Vasc. Anesth. · Feb 2022

    Review

    ECPella: Concept, Physiology and Clinical Applications.

    • P Meani, R Lorusso, and F Pappalardo.
    • Department of Cardiothoracic and Vascular Anesthesia and Intensive Care Unit (ICU), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, San Donato Milanese, Milan, Italy; ECLS Centrum, Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht (MUMC), P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands. Electronic address: paolo.meani@mumc.nl.
    • J. Cardiothorac. Vasc. Anesth. 2022 Feb 1; 36 (2): 557-566.

    AbstractAddition 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.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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