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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 IikuraYIYuki IkedaSNS. Nakahara

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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