Combining VA-ECMO and Impella (EC-Pella) Before Reperfusion Mitigates Left Ventricular Injury Due to VA-ECMO in Acute Myocardial Infarction

• Published in: The Journal of heart and lung transplantation Vol. 41; no. 4; pp. S185 - S186
• Main Authors: Everett, K.D., Swain, L., Reyelt, L., Majumdar, M., Qiao, X., Bhave, S., Warner, M., Mahmoudi, E., Surks, W., Aryaputra, T., Goel, S., Kapur, N.K.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2022
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2022.01.1600

Combining veno-arterial extracorporeal membrane oxygenation (ECMO) with an Impella CP (EC-Pella) is increasingly used in acute myocardial infarction (AMI). We recently reported that compared to reperfusion alone, ECMO increases, but Impella decreases infarct size in preclinical models. Whether EC-Pella limits cardiac damage remains unknown. We hypothesized that compared to ECMO alone, EC-Pella mitigates left ventricular (LV) injury when activated before reperfusion in AMI. Ischemia-reperfusion injury (IRI) was induced in adult swine via percutaneous occlusion of the left anterior descending artery (LAD) for 120 minutes. We then activated either ECMO alone for 30 minutes or EC-Pella for 45 minutes with persistent LAD occlusion. All groups underwent 180 minutes of reperfusion (n=4-6/group). To study whether the sequence of device activation impacts infarct size, we compared activation of ECMO alone for 30 minutes followed by simultaneous Impella CP for 15 minutes (EC-Pella A) versus Impella CP activation for 30 minutes followed by simultaneous ECMO for 15 minutes (EC-Pella B) before reperfusion. LV hemodynamics, infarct size relative to the area at risk (IS) and cardioprotective signaling were assessed. Compared to IRI, ECMO increased IS. Compared to ECMO, IS was reduced in both EC-Pella groups (Fig. 1A). No difference in IS was observed between EC-Pella A versus EC-Pella B. Pressure-volume area (PVA) was lowest in EC-Pella B (Fig. 1B). Compared to IRI and ECMO, both EC-Pella configurations increased levels of phosphorylated Akt, Erk, and GSK3b within the infarct zone (Fig. 1C) and reduced pro-apoptotic signaling. We report for the first time that compared to ECMO alone, initiation of EC-Pella before reperfusion reduces LV PVA, activates cardioprotective signaling, and reduces infarct size. These findings suggest that LV unloading may mitigate LV injury due to ECMO when applied before reperfusion in AMI.