Why the study?
In Takotsubo cardiomyopathy due to pheochromocytoma with cardiogenic shock, treatment is difficult because exogenous catecholamines can worsen outcomes, and Impella may be effective during refractory cardiac arrest by unloading the left ventricle.
Impella may be an effective alternative to va-ECMO for obtaining ROSC in patients with refractory cardiac arrest and left ventricular overload due to pheochromocytoma-induced Takotsubo cardiomyopathy.
Hypothesis-generating for Impella in refractory arrest with LV overload; leaves open its role versus VA-ECMO in Takotsubo cardiomyopathy.
In the clinical scenario of Takotsubo cardiomyopathy due to pheochromocytoma, when cardiogenic shock develops treatment is difficult because exogenous catecholamines, required to maintain organ perfusion, could exacerbate hypertension and deteriorate the cardiomyopathy. Moreover, as the coronary perfusion pressure is critically reduced, refractory cardiac arrest could develop. Although veno-arterial extra-corporeal membrane oxygenation (va-ECMO) has been advocated as the treatment of choice for in-hospital refractory cardiac arrest, in the presence of left ventricular overload a device like Impella®, which carries fewer complications as compared to ECMO, could be effective in obtaining the ROSC by unloading the left ventricle.
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Zilio et al. (2021) studied this question.
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