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February 23, 2026Circulation Reports1 citationsOpen Access

Short-Term Outcomes of Intra-Aortic Balloon Pump vs. Microaxial Flow Pump for Fulminant Myocarditis Supported by Venoarterial Extracorporeal Membrane Oxygenation

SISaeko IikuraKitasato UniversityYIYuki IkedaSasebo City General HospitalSNS. NakaharaKitasato University

Key Result

Use of Impella for LV unloading reduced 30-day composite of all-cause mortality or exVAD implantation to 8% versus 53% with IABP in fulminant myocarditis patients on VA-ECMO.

Key Points

  • This research aims to compare the effectiveness of intra-aortic balloon pump and microaxial flow pump for left ventricular unloading in fulminant myocarditis patients supported by venoarterial ECMO.
  • Retrospective analysis of clinical data
  • Comparison of hemodynamic parameters between IABP and Impella
  • Patient outcomes were analyzed regarding LV unloading efficiency.
  • IABP and Impella showed different hemodynamic impacts on left ventricular unloading.
  • Impella demonstrated greater cardiac support than IABP in preliminary assessments.
  • Survival rates in patients supported by each pump were assessed but details were not quantified.

Study Design

Type

Cohort (n=27)

Multicenter

No

Structured PICO

Does a microaxial flow pump (Impella) improve the composite of 30-day mortality or exVAD implantation compared to an intra-aortic balloon pump (IABP) in patients with fulminant myocarditis supported by VA-ECMO?

P
Population
27 patients with lymphocytic fulminant myocarditis (FM) treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO), median age 43, 52% male, single-center in Japan. Excluded if received VA-ECMO alone, escalated from IABP to Impella >24h after IABP initiation, or required escalation to exVAD within 24h of IABP support.
I
Intervention
Microaxial flow pump (Impella 2.5 or Impella CP) for left ventricular unloading added to VA-ECMO support.
C
Comparator
Intra-aortic balloon pump (IABP) for left ventricular unloading added to VA-ECMO support.
O
Outcome
Composite of all-cause mortality or extracorporeal ventricular assist device (exVAD) implantation within 30 days of VA-ECMO initiation.composite

In patients with fulminant myocarditis requiring VA-ECMO, left ventricular unloading with a microaxial flow pump (Impella) was associated with improved short-term survival free from exVAD implantation compared to IABP, though with a higher risk of hemolysis.

Main Result

Effect estimate: HR not reported but Log-rank P=0.018 favoring Impella group

Absolute Event Rate: 8% vs 53%

p-value: p=0.009

Limitations

  • Single-center, retrospective cohort study with small sample size (n=27), limiting statistical power and generalizability.
  • Potential temporal bias as Impella only available after 2019 and IABP mostly before 2019; improvements in care over time may confound results.
  • No uniform protocol for mechanical circulatory support initiation or management; device choice at physician discretion.
  • Only lymphocytic myocarditis included; findings cannot be generalized to other myocarditis types or MCS strategies.
  • Hemodynamic parameters under VA-ECMO difficult to interpret due to right atrial drainage effects.
  • Multivariable adjustment not feasible due to limited events.
  • Possible confounding by difference in duration of LV unloading support between groups.
  • Single-center study with a limited sample size
  • Historical bias (IABP used before 2019, Impella from 2019 onward)
  • No standardized protocol for MCS initiation, management, escalation, or de-escalation
  • Multivariable analysis not feasible due to small sample size

Abstract

Background: The clinical differences between intra-aortic balloon pumping (IABP) and a microaxial flow pump (Impella) for left ventricular (LV) unloading in patients with fulminant myocarditis (FM) supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO) remain unclear.

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Cite This Study

Iikura et al. (2026) conducted a cohort in fulminant myocarditis (n=27). Impella microaxial flow pump vs. intra-aortic balloon pump (IABP) was evaluated on composite of all-cause mortality or extracorporeal ventricular assist device (exVAD) implantation within 30 days of VA-ECMO initiation (HR not reported but Log-rank P=0.018 favoring Impella group, p=0.009). Use of Impella for LV unloading reduced 30-day composite of all-cause mortality or exVAD implantation to 8% versus 53% with IABP in fulminant myocarditis patients on VA-ECMO.

synapsesocial.com/papers/699bee1c1c6c6bad5397fe0bhttps://doi.org/10.1253/circrep.cr-25-0283
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