JCS/JSCVS/JCC/CVIT 2023 Guideline Focused Update on Indication and Operation of PCPS/ECMO/IMPELLA

Abstract

2 JCS/JSCVS/JCC/CVIT 2023 Guideline Focused Update on Indication and Operation of PCPS/ECMO/IMPELLA individual facilities.Therefore, in this Focus Update, specific classes or levels of evidence are not strictly mandatory, but rather they are presented as expert consensus.However, we strongly hope that this Focus Update will (1) serve as a guideline for the standardization of PCPS, ECMO, and IMPELLA therapy within Japan, (2) be widely used by various healthcare professionals including physicians, nurses, clinical engineers, and other professionals involved in this treatment, and (3) be continuously revised in the future.I. Indications for PCPS, ECMO, and IMPELLA Indicated Diseases and ConditionsIMPELLA and veno-arterial extracorporeal membrane oxygenation (V-A ECMO) have different support mechanisms and approaches to their application, and their use alone or in combination should be considered according to the patient's condition.For device selection, please refer to Section 8 (Device Selection for Temporary MCS) later in this chapter.Regarding the clinical results of V-A ECMO in Japan, an analysis of diagnosis-procedure combination (DPC) data of 5,263 patients, showed that 64.4% were weaned, but the subsequent in-hospital mortality rate was as high as 37.9%. 5J-PVAD (Japanese registry for Percutaneous Ventricular Assist Device), a registry of IMPELLA in Japan, reported the initial results of 823 patients: 30-day survival rates for patients treated with IMPELLA alone and ECPELLA (V-A ECMO plus IMPELLA) were 81.1% and 49.6%, respectively. 1