• Letizia F Bertoldi, Federico Pappalardo, Edith Lubos, Hanno Grahn, Meike Rybczinski, Markus J Barten, Tim Legros, Luca Bertoglio, Benedikt Schrage, Dirk Westermann, Elisabetta Lapenna, Hermann Reichenspurner, and Alexander M Bernhardt.
• IRCCS San Raffaele Scientific Institute, Milan, Italy.
• J Crit Care. 2020 Jun 1; 57: 259-263.

PurposeVeno-arterial extracorporeal membrane oxygenation (VA-ECMO) stabilizes patients in refractory cardiogenic shock. However, ECMO-related complications strongly affect the outcome, especially if a long-term LVAD is needed.Methods And MaterialsWe describe a new strategy in management of INTERMACS 1 patients consisting in early weaning from VA-ECMO with axillary Impella 5.0 as a bridge to LVAD implantation. Nine patients in two European centres are described.ResultsAll patients were implanted with VA-ECMO for initial hemodynamic and metabolic stabilization. After a median time of 8 days, Impella 5.0 was implanted. Impella support allowed in all patients weaning from inotropes and from VA-ECMO (after a median time of 22 h). No patients had right ventricular failure after ECMO-weaning and most patients were mobilized and orally fed (88.9%) during Impella support. All patient underwent LVAD implantation after a median Impella time of 17 days. Only one patient had right-ventricular failure after LVAD implantation. All patients were discharged from hospital after a median time of 40 days.ConclusionEarly weaning from VA-ECMO with Impella 5.0 as a bridge to LVAD is a safe and effective strategy in management of INTERMACS 1 patients. This approach minimizes ECMO-related complications and allows patient mobilization and right ventricular function optimization before LVAD implantation.Copyright © 2019. Published by Elsevier Inc.

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