Effectiveness of an Impella versus intra-aortic balloon pump in patients who received extracorporeal membrane oxygenation

Background Previous studies have suggested that left ventricular (LV) unloading with an intra-aortic balloon pump (IABP) or percutaneous ventricular assist device (Impella) in combination with extracorporeal membrane oxygenation (ECMO) is associated with lower mortality; however, it is unclear which is better. This study aimed to evaluate the effectiveness of LV unloading with an Impella versus IABP on in-hospital mortality and other clinical outcomes. Methods Using the Japanese Diagnosis Procedure Combination database from September 28, 2016, to March 31, 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 were the length of hospital stay, length of ECMO, total hospitalization cost, and complications. Propensity score matching was performed to compare the outcomes between the groups. Results Of 14,525 eligible patients, 603 (4.2%) received ECPella and 13,922 (96%) received ECMO+IABP. After propensity score matching, there was no significant difference in in-hospital mortality between the two groups (58.9% versus 56.6%; risk difference, 2.3%; 95% confidence interval, −3.9% to 8.5%). The ECPella group had a longer hospital stay, higher total hospitalization cost, and more frequent major bleeding, vascular complications, and renal replacement therapy during hospitalization than the ECMO+IABP group. Conclusions This nationwide inpatient database study showed that ECPella was not associated with a survival benefit but was associated with a longer hospital stay, higher total hospitalization cost, and more complications than ECMO+IABP. ### Competing Interest Statement Drs. Nishimoto and Nakata received lecture fees from Abiomed Japan. All other authors declare that they have no conflict of interest. ### Clinical Trial N/A ### Funding Statement This research was funded by grants from the Ministry of Health, Labour and Welfare, Japan, grant numbers 23AA2003 and 22AA2003. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was performed in accordance with the amended Declaration of Helsinki, and the Institutional Review Board of The University of Tokyo approved this study (approval number: 3501-(3); 25 December 2017). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes