Impella CP With VA ECMO for Cardiogenic Shock

NCT03431467 | Terminated Results DMC FDA Device

• 1 other identifier: 828198
• Study Type: interventional
• Target: 17
• Locations: 1 country
• Sites: 1

Brief Summary

Veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) is indicated as a haemodynamic rescue strategy in decompensated acute or chronic heart failure presenting as cardiogenic shock. It has been used across aeitologies including post-myocardial infarction, dilated cardiomyopathy, acute myocarditis and in post-cardiotomy shock. VA ECMO has a number of effects on the circulation including improved end-organ perfusion and possibly improved coronary perfusion, and is a bridge to further therapies including permanent advanced mechanical circulatory support, cardiac transplantation and to cardiac recovery. Left ventricular assist devices (LVADs) provide long-term mechanical circulatory support and also profoundly mechanically unload the left ventricle. Multiple clinical studies have documented cardiac recovery using LVAD therapy, with a rate between 10-60% in selected populations. A large body of basic science has documented the pivotal role of mechanical load in determining ventricular contractile performance across species. Therefore both clinical data and basic laboratory studies support the notion that profound ventricular unloading may result in improved cardiac performance through a variety of mechanisms ranging from triggered de novo cardiomyocyte proliferation, subcellular calcium handling reverse remodeling, changes to the extracellular matrix of the heart, reverse remodeling of the neurohormal milleu, amongst many others. One of the major deficiencies of peripheral VA-ECMO is its lack of left ventricular unloading, with associated pulmonary congestion, which can derail clinical improvement and hamper cardiac recovery. Indeed, percutaneous VA-ECMO increases LV afterload due to the retrograde blood flow, and because of the lack of venting, there may be progressive LV distension. These conditions can result in a congested, pressure-overloaded ventricle, even in the absence of echocardiographic ventricular distension. This may be ameliorated with the addition of ventricular mechanical unloading using percutaneous therapies including the percutaneous left ventricular device, Impella CP. On the platform of VA-ECMO, the addition of an Impella device to reduce ventricular loading results in improved survival and recovery of ventricular performance in the setting of cardiogenic shock. In a number of small studies, the use of additional means to unload the ventricle, principally Impella, results in cardiac recovery and less ventricular distension. In chronic heart failure, direct ventricular unloading is critical to cardiac recovery. The objective of this randomized study is to determine whether the addition of early direct ventricular unloading using Impella CP leads to higher rates of cardiac recovery, defined as survival free from mechanical circulatory support, heart transplantation or inotropic support at thirty days. This study will also examine the clinical, biochemical, echocardiographic and radiologic effects of VA ECMO with and without the addition of Impella CP to directly vent the left ventricle to address adjunct important questions such as the effects on pulmonary congestion.

Conditions

Cardiogenic Shock

Keywords

ECMO; Heart Failure; RCT; Mechanical unloading

Outcome Measures

Primary Outcomes (1)

• Recovery From Cardiogenic Shock.

  The number of subjects treated with this standardized ECMO protocol with either (i) no additional therapy or (ii) Impella CP for LV mechanical unloading who experience myocardial recovery defined as: survival free from mechanical circulatory support, heart transplantation or inotropic support.

  At forty five days.

Study Arms (2)

Control

NO INTERVENTION

VA-ECMO alone per standard clinical protocol.

Experimental

EXPERIMENTAL

VA-ECMO with early institution of Impella CP LV venting

Device: Impella-CP LV Vent

Interventions

Impella-CP LV Vent DEVICE

Patients randomised to the experimental arm will have an Impella-CP implanted in addition to VA-ECMO within a maximum of 10 hours of institution of VA-ECMO

Experimental

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Cardiogenic shock: Including refractory to conventional therapy, including systolic blood pressure \< 90mm Hg, Cardiac Index \< 1.8 or a cardiac index \< 2.0 on moderate to high doses of inotropes and vasopressors for greater than 30 mins, or systemic signs of tissue hypoxia.
• Post-acute myocardial infarction cardiogenic shock: excluding mechanical complications requiring surgical intervention after extracorpeal membrane oxygenator (ECMO) such as post-ischaemic ventricular septal defect (VSD).
• Drug overdose-induced cardiogenic shock.
• Early graft failure: post orthotropic heart transplantation cardiogenic shock, excluding immediate intra-operative failure.
• Acute on chronic cardiomyopathy with progressive shock and decompensation unresponsive to medical therapies.

You may not qualify if:

• Recent Significant Pulmonary Embolus
• Moderate to severe aortic valve insufficiency (AI)
• Ongoing significant sepsis
• Severe pulmonary hypertension \& shock
• Hypothermia
• Post-cardiotomy cardiogenic shock
• Continuous cardiopulmonary resuscitation (CPR) \>20-30 minutes, except if neurological status is satisfactory
• Transfer from outside hospital on VA ECMO or with history of CPR
• Listed for cardiopulmonary transplantation or being evaluated for cardiopulmonary transplantation or permanent mechanical circulatory support
• Known or suspected chronic heart failure with echocardiogram documenting left ventricular diastolic diameter \>6.5cm
• Known or suspected chronic heart failure with echocardiogram documenting left ventricular ejection fraction \< 25%
• Mechanical aortic valve replacement
• Presence of left ventricular thrombus
• Pre-existing Impella 2.5, CP, 3.5 or 5.0
• Cardiogenic shock due to primary respiratory failure

Sponsors & Collaborators

• University of Pennsylvania: lead

Study Sites (1)

Hospital of The University of Pennsylvania

Philadelphia, Pennsylvania, 19104, United States

Location

MeSH Terms

Conditions

Shock, Cardiogenic; Heart Failure

Condition Hierarchy (Ancestors)

Myocardial Infarction; Myocardial Ischemia; Heart Diseases; Cardiovascular Diseases; Vascular Diseases; Infarction; Ischemia; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Necrosis; Shock

Limitations and Caveats

1. Difficulty in enrollment due to the perception of needing infrequent unloading and/or that unloading was not necessary. 2. Impella 5.5 was released during the trial. Impella 5.5 was. more potent that the Impella CP. 3. COVID-19 pandemic restrictions.

Results Point of Contact

• Title: Dr. Christian Bermudez
• Organization: The Hospital of the University of Pennsylvania

christian.bermudez@pennmedicine.upenn.edu

2153165151

Study Officials

• Christian Bermudez, MD

  University of Pennsylvania

  PRINCIPAL INVESTIGATOR

• Michael Ibrahim, MD PhD

  University of Pennsylvania

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: All data will be masked as far as possible. For example, Echo data will be masked
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Co-Principal Investogator

Model Details: Randomised controlled trial at three U Penn Sites

Study Record Dates

• First Submitted: January 21, 2018
• First Posted: February 13, 2018
• Study Start: March 19, 2018
• Primary Completion: September 1, 2023
• Study Completion: September 1, 2023
• Last Updated: November 19, 2025
• Results First Posted: November 19, 2025

Record last verified: 2025-11

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)