Abstract：
We report the largest pediatric multicenter experience with Impella pump use and peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support. Utilizing the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) collaborative database, we conducted a retrospective, multicenter study of all patients with cardiogenic shock requiring VA-ECMO support with subsequent Impella implant between October 2014 and December 2021. The primary outcome was defined as death while on Impella support. Secondary outcomes were recovery, transplantation, and transition to durable ventricular assist device (VAD) at the time of Impella explantation. Adverse events were defined according to the ACTION registry criteria. Twenty subjects were supported with Impella; Impella 2.5 (n = 3), CP (n = 12), 5.0/5.5 (n = 5). The median Interquartile range (IQR) age, weight, and body surface area at implantation were 15.6 years (IQR = 13.9-17.2), 65.7 kg (IQR = 53.1-80.7), and 1.74 m2 (IQR = 1.58-1.98). Primary cardiac diagnoses were dilated cardiomyopathy/myocarditis in nine (45%), congenital heart disease in four (20%), graft failure/rejection in four (20%), and three (15%) others. Most common adverse events included hemolysis (50%) and bleeding (20%). There were two deaths (10%) in the cohort. Nine patients (45%) were explanted for recovery, eight (40%) were transitioned to a durable VAD, and one (5%) underwent heart transplantation. Impella percutaneous pump support should be considered in the older pediatric population supported with peripheral VA-ECMO, as a means of left heart decompression, and a strategy to come off ECMO to achieve endpoints of myocardial recovery, transition to a durable VAD, or transplantation.
摘要：
我们报告了使用Impella泵和外周静脉动脉体外膜氧合（VA-ECMO）支持的最大儿科多中心经验。利用高级心脏疗法改善结果网络（ACTION）协作数据库，我们做了一个回顾,2014年10月至2021年12月期间，所有需要VA-ECMO支持并随后植入Impella的心源性休克患者的多中心研究。主要结局定义为Impella支持下死亡。次要结果是恢复，移植,并在Impella植入时过渡到耐用的心室辅助装置（VAD）。根据ACTION注册标准定义不良事件。20名受试者用Impella支持；Impella2.5(n=3)，CP（n=12），5.0/5.5（n=5）。四分位距中位数(IQR)年龄，体重,植入时的体表面积为15.6年（IQR=13.9-17.2），65.7千克（IQR=53.1-80.7），和1.74平方米（IQR=1.58-1.98）。主要的心脏诊断为9例（45％）的扩张型心肌病/心肌炎，先天性心脏病四例（20%），移植失败/排斥在四个（20％），三个（15%）。最常见的不良事件包括溶血（50%）和出血（20%）。该队列中有2例死亡（10％）。9名患者（45％）被移植恢复，八人(40%)过渡到持久的VAD，1人(5%)接受了心脏移植。在接受外周VA-ECMO支持的老年儿科人群中，应考虑Impella经皮泵支持。作为左心减压的一种手段，以及脱离ECMO以达到心肌恢复终点的策略，过渡到耐用的VAD，或移植。
