Among patients treated by temporary mechanical circulatory support (tMCS) for refractory cardiogenic shock, some of them suffer from persistent cardiac dysfunction incompatible with a successful weaning. In eligible patients, the heart transplantation is still the gold standard therapy. However, due to the shortage of grafts and/or contraindications, some patients will not be transplanted. In these patients, for whom the Left ventricular Assist Device (LVAD) represents an alternative therapy, the best approach of tMCS as a bridge to durable LVAD remains to be clarified.

We tested the hypothesis that the use of IMPELLA® as bridge to LVAD should improve early postoperative outcomes by offering the opportunité of active rehabilitation under tMCS.

The ECI-BLAD trial was a multicentre retrospective study including adults, supported with IMPELLA® or ECLS as a bridge to LVAD between January 2012 and December 2020 in 5 French cardiac intensive care units. The IMPELLA® group included patients assisted by an IMPELLA® alone at least five days prior the implantation of the LVAD while the ECLS group included patients treated by a ECLS with or without IMPELLA®. The primary endpoint was the proportion of patients alive with a John Hopkins Highest Level of Mobility score = 8, discharged from the critical care unit and not perfused at 30 days after LVAD implantation. Secondary endpoints included rehabilitation under tMCS (tracheal extubation, mobilization to chair, walking and cyclo-ergometer), 6-month survival rate after the LVAD implantation. This study was approved by our ethics committee and registered on Clinical trials ( NCT04480151 ).

From 388 consecutive patients implanted by LVAD, 92 patients treated as bridge to LVAD have been included in our study (ECLS group n = 42/IMPELLA group n = 50). Most of patients of IMPELLA group (72%) were implanted through an axillary approach. Early mobilization on tMCS was more frequently achieved in IMPELLA group (seating 50% vs 2%, P < 0.001 and walking 18% vs 0%, P < 0.01). A larger proportion of patients in IMPELLA group reached the primary endpoint (52% vs 26%, P = 0.018). The 6-month survival rate after LVAD implantation was significantly better in IMPELLA group ( Fig. 1 ).

Implantation of IMPELLA through axillary approach as bridge to LVAD by allowing active and early rehabilitation might be associated with better outcomes.