# Utility of Adjunctive Impella Support to Venoarterial Extracorporeal Membrane Oxygenation for a Refractory Electrical Storm

## TL;DR

This case study shows how combining Impella support with VA-ECMO can help manage a severe heart condition unresponsive to standard treatments.

## Contribution

The study presents a novel approach using Impella to reduce left ventricular strain during VA-ECMO in refractory electrical storms.

## Key findings

- VA-ECMO alone increases left ventricular afterload and pressure.
- Adding Impella support may improve outcomes by unloading the left ventricle.
- The combination was effective in a case resistant to defibrillation.

## Abstract

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) stabilizes hemodynamics in an electrical storm leading to cardiogenic shock. However, adverse effects of VA-ECMO are increased left ventricular (LV) afterload and LV end-diastolic pressure due to retrograde blood return. These adverse effects could be ameliorated by LV unloading with Impella insertion. This case illustrates the possible efficacy of adjunctive Impella insertion for a refractory electrical storm that is resistant to defibrillation under mechanical support with VA-ECMO for cardiogenic shock.