Profil et devenir des patients en choc cardiogénique réfractaire traités par ECLS, IMPELLA ou en association. Expérience d’un centre sur une période de 12 ans

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Introduction. The use of temporary circulatory support (TCS) devices for refractory cardiogenic shock is rapidly evolving since the 2000s. According to 2015 French recommendations, Extra Corporeal Life Support (ECLS) is the gold standard. Since 2007, intracardiac axial micropumps such as IMPELLA are an available therapeutic that may represent a complement or an alternative to ECLS. The aim of this study is to describe and compare short term mechanical circulatory support (STMCS) activity using ECLS and/or IMPELLA CP and 5.0 within the cardiac intensive care unit of Bordeaux University Hospital. Methods. This is a retrospective cohort study realised over a 12 years period (between January 2007 and June 2018) within Bordeaux University Hospital. The main outcome was survival at one year of follow up. Results. During this period, 366 consecutive patients were included, 267 (73%) were treated using an ECLS alone, 48 (13%) using an IMPELLA alone and 51 (14%) using an association of both ECLS and IMPELLA (simultaneously or sequentially). Annual activity of TCS is growing over the studied period with a more and more frequent recourse to IMPELLA since 2010. Survival at discharge from ICU was 63% in the ECLS group, 53% in ECMELLA and significantly higher in IMPELLA group with 79% (p=0.02). At one year of follow-up, survival was significantly different in each group (ECLS 51%, ECMELLA 29% and IMPELLA 71%, p=0.0004). At least one complication occurred in 67% of patients (sepsis in 52% and severe hemorrhage in 42% of cases). Conclusion. STMCS have confirmed their place over the last decade as a treatment for refractory cardiogenic shock, offering hope for patients affected by this high mortality condition. IMPELLA use (alone or combined to ECLS) seems to be related to patient’s outcome.

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