Effectiveness of an Impella Versus Intra‐Aortic Balloon Pump in Patients Who Received Extracorporeal Membrane Oxygenation
Background It is unclear whether an intra‐aortic balloon pump (IABP) or percutaneous ventricular assist device (Impella) in combination with extracorporeal membrane oxygenation (ECMO) is better. Methods Using the Japanese Diagnosis Procedure Combination database from September 2016 to March 2022, we...
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Wiley
2025-02-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.037652 |
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| author | Yuji Nishimoto Hiroyuki Ohbe Jun Nakata Toru Takiguchi Mikio Nakajima Yusuke Sasabuchi Toshiaki Isogai Hiroki Matsui Yukihito Sato Tetsuya Watanabe Takahisa Yamada Masatake Fukunami Hideo Yasunaga |
| author_facet | Yuji Nishimoto Hiroyuki Ohbe Jun Nakata Toru Takiguchi Mikio Nakajima Yusuke Sasabuchi Toshiaki Isogai Hiroki Matsui Yukihito Sato Tetsuya Watanabe Takahisa Yamada Masatake Fukunami Hideo Yasunaga |
| author_sort | Yuji Nishimoto |
| collection | DOAJ |
| description | Background It is unclear whether an intra‐aortic balloon pump (IABP) or percutaneous ventricular assist device (Impella) in combination with extracorporeal membrane oxygenation (ECMO) is better. Methods Using the Japanese Diagnosis Procedure Combination database from September 2016 to March 2022, we identified inpatients who received an Impella or IABP in combination with ECMO (ECPella or ECMO+IABP group, respectively). The primary outcome was in‐hospital mortality, and the secondary outcomes included the length of hospital stay, length of ECMO, total hospitalization cost, complications, and durable mechanical circulatory support implantations. Propensity score matching was performed to compare the outcomes between the groups. Results Of 14 319 eligible patients, 590 (4.1%) received ECPella and 13 729 (96%) received ECMO+IABP. The mean age of patients was 65 years, 77% were men, and 57% had acute coronary syndrome. After propensity score matching, the patient characteristics were well balanced between the groups. The 14‐day mortality rate was lower in the ECPella group than in the ECMO+IABP group (28.0% versus 36.8%; risk difference, −8.2% [95% CI, −13.8 to −2.7]), whereas there was no significant difference in in‐hospital mortality between the groups (58.3% versus 56.6%; risk difference, 2.4% [95% CI, −3.5 to 8.2]). The ECPella group had a higher total hospitalization cost, increased renal replacement therapy during hospitalization, and more durable mechanical circulatory support implantations than the ECMO+IABP group. Conclusions This nationwide inpatient database study showed no significant difference in in‐hospital mortality between the groups, but ECPella was associated with a higher total hospitalization cost, increased renal replacement therapy during hospitalization, and more durable mechanical circulatory support implantations than ECMO+IABP. |
| format | Article |
| id | doaj-art-2ef12b7139a6419c863243ad28d93b95 |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-2ef12b7139a6419c863243ad28d93b952025-02-04T11:00:01ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-02-0114310.1161/JAHA.124.037652Effectiveness of an Impella Versus Intra‐Aortic Balloon Pump in Patients Who Received Extracorporeal Membrane OxygenationYuji Nishimoto0Hiroyuki Ohbe1Jun Nakata2Toru Takiguchi3Mikio Nakajima4Yusuke Sasabuchi5Toshiaki Isogai6Hiroki Matsui7Yukihito Sato8Tetsuya Watanabe9Takahisa Yamada10Masatake Fukunami11Hideo Yasunaga12Division of Cardiology Osaka General Medical Center Osaka JapanDepartment of Clinical Epidemiology and Health Economics, School of Public Health The University of Tokyo JapanDivision of Cardiovascular Intensive Care Nippon Medical School Tokyo JapanDepartment of Emergency and Critical Care Medicine Nippon Medical School Tokyo JapanDepartment of Clinical Epidemiology and Health Economics, School of Public Health The University of Tokyo JapanDepartment of Real‐world Evidence, Graduate School of Medicine The University of Tokyo JapanDepartment of Clinical Epidemiology and Health Economics, School of Public Health The University of Tokyo JapanDepartment of Clinical Epidemiology and Health Economics, School of Public Health The University of Tokyo JapanDepartment of Cardiology Hyogo Prefectural Amagasaki General Medical Center Amagasaki JapanDivision of Cardiology Osaka General Medical Center Osaka JapanDivision of Cardiology Osaka General Medical Center Osaka JapanDivision of Cardiology Osaka General Medical Center Osaka JapanDepartment of Clinical Epidemiology and Health Economics, School of Public Health The University of Tokyo JapanBackground It is unclear whether an intra‐aortic balloon pump (IABP) or percutaneous ventricular assist device (Impella) in combination with extracorporeal membrane oxygenation (ECMO) is better. Methods Using the Japanese Diagnosis Procedure Combination database from September 2016 to March 2022, we identified inpatients who received an Impella or IABP in combination with ECMO (ECPella or ECMO+IABP group, respectively). The primary outcome was in‐hospital mortality, and the secondary outcomes included the length of hospital stay, length of ECMO, total hospitalization cost, complications, and durable mechanical circulatory support implantations. Propensity score matching was performed to compare the outcomes between the groups. Results Of 14 319 eligible patients, 590 (4.1%) received ECPella and 13 729 (96%) received ECMO+IABP. The mean age of patients was 65 years, 77% were men, and 57% had acute coronary syndrome. After propensity score matching, the patient characteristics were well balanced between the groups. The 14‐day mortality rate was lower in the ECPella group than in the ECMO+IABP group (28.0% versus 36.8%; risk difference, −8.2% [95% CI, −13.8 to −2.7]), whereas there was no significant difference in in‐hospital mortality between the groups (58.3% versus 56.6%; risk difference, 2.4% [95% CI, −3.5 to 8.2]). The ECPella group had a higher total hospitalization cost, increased renal replacement therapy during hospitalization, and more durable mechanical circulatory support implantations than the ECMO+IABP group. Conclusions This nationwide inpatient database study showed no significant difference in in‐hospital mortality between the groups, but ECPella was associated with a higher total hospitalization cost, increased renal replacement therapy during hospitalization, and more durable mechanical circulatory support implantations than ECMO+IABP.https://www.ahajournals.org/doi/10.1161/JAHA.124.037652cardiogenic shockextracorporeal membrane oxygenationheart assist deviceintra‐aortic balloon pumpmechanical circulatory support |
| spellingShingle | Yuji Nishimoto Hiroyuki Ohbe Jun Nakata Toru Takiguchi Mikio Nakajima Yusuke Sasabuchi Toshiaki Isogai Hiroki Matsui Yukihito Sato Tetsuya Watanabe Takahisa Yamada Masatake Fukunami Hideo Yasunaga Effectiveness of an Impella Versus Intra‐Aortic Balloon Pump in Patients Who Received Extracorporeal Membrane Oxygenation Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiogenic shock extracorporeal membrane oxygenation heart assist device intra‐aortic balloon pump mechanical circulatory support |
| title | Effectiveness of an Impella Versus Intra‐Aortic Balloon Pump in Patients Who Received Extracorporeal Membrane Oxygenation |
| title_full | Effectiveness of an Impella Versus Intra‐Aortic Balloon Pump in Patients Who Received Extracorporeal Membrane Oxygenation |
| title_fullStr | Effectiveness of an Impella Versus Intra‐Aortic Balloon Pump in Patients Who Received Extracorporeal Membrane Oxygenation |
| title_full_unstemmed | Effectiveness of an Impella Versus Intra‐Aortic Balloon Pump in Patients Who Received Extracorporeal Membrane Oxygenation |
| title_short | Effectiveness of an Impella Versus Intra‐Aortic Balloon Pump in Patients Who Received Extracorporeal Membrane Oxygenation |
| title_sort | effectiveness of an impella versus intra aortic balloon pump in patients who received extracorporeal membrane oxygenation |
| topic | cardiogenic shock extracorporeal membrane oxygenation heart assist device intra‐aortic balloon pump mechanical circulatory support |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.037652 |
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