The Critical Care Commute Podcast
Extracorporeal Support in Cardiogenic Shock - A Look at the Evidence with Dr Sean van Diepen
Mar 13, 2025
Dr. Sean van Diepen, an Associate Professor and Co-Director at the Mazankowski Alberta Heart Institute, shares his expertise on extracorporeal life support in cardiogenic shock. He discusses the evolution of mechanical circulatory support, highlighting findings from the DANGER trial showing a 20% mortality reduction with the Impella device. The ECLS-SHOCK trial raises concerns about complications despite lack of mortality benefit. Van Diepen emphasizes the need for better patient selection and collaborative care in this critical area of cardiac medicine.
22:37
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Quick takeaways
- Extracorporeal life support, particularly the Impella device, has shown a 20% mortality reduction in cardiogenic shock but raises concerns about complications and cost.
- The evolving landscape of ECPR highlights logistical challenges and ethical concerns, emphasizing the need for standardized protocols for better patient outcomes.
Deep dives
The Evolution of Extracorporeal Support in Cardiac Care
Extracorporeal life support (ECLS) has seen significant advancements, particularly in its application for acute myocardial infarction with cardiogenic shock. Over the past 25 years, various clinical trials have explored its effectiveness, culminating in the recent danger trial, which demonstrated a 20% reduction in all-cause mortality for patients with AMI supported by the Impella device. However, the challenges of patient selection, complications, and the high costs associated with these devices continue to complicate their use. The implications of the trial’s outcomes suggest that while the Impella can be beneficial, it must be utilized judiciously to avoid excessive complications and ensure equitable access in healthcare systems.
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