ELSO 2022 Q&A with Evgenij Potapov, Roberto Lorusso, and Alan Gass

In this Q&A session from the Extracorporeal Life Support Organization (ELSO) meeting in 2022, Professor Roberto Lorusso, MD, Alan Gass, MD, and Professor Evgenij Potapov, MD, discuss the importance of LV unloading for heart recovery, balancing Impella 5.5® with SmartAssist® heart pump and ECMO flows, weaning, and other aspects of managing ECpella patients. They also address a question regarding ECpella and ventricular tachycardia.

Dr. Lorusso, who has published extensively on the concept of LV unloading during ECMO, discusses the timing of LV unloading and clinical indicators of the need for unloading. “The importance of unloading for heart recovery after injury is well known,” states Dr. Lorusso, noting that cardiac surgeons have known that for decades. “So LV unloading should be done, in my point of view, during ECMO all the time.” With regard to how to unload, he emphasizes, “It’s really clear that Impella [system] is the most powerful left ventricular unloading and venting technique.” While acknowledging that the Impella heart pump is not available to all clinicians, he emphasizes, “left ventricular unloading should be done in a non-invasive or invasive way from time zero.”

Dr. Gass speaks about the “paradigm shift” he has seen in his practice with unloading as the key to native heart recovery. He highlights his strategy of employing ECpella and weaning patients from ECMO within a day or 2 and leaving them on Impella 5.5 with SmartAssist device support until recovery, transplant, or LVAD. He also discusses how the Impella heart pump enables him to balance the pump and ECMO flows to enable early weaning from ECMO.

Dr. Potapov answers a question about use of the Impella device in patients with biventricular failure and shock with myocarditis and whether this will induce VT storm. He states that ECMella is ideal in these patients, explaining that in these patient biventricular failure is primarily left ventricular failure with subsequent right ventricular failure due to factors such as high right ventricular afterload and pulmonary edema. “So if you unload the left ventricle with Impella [heart pumps], you treat right ventricular failure.”