Clinical indications and outcomes of Impella devices for severe cardiogenic shock in COVID-19 patients: a systematic review

Abstract

Background: Coronavirus disease 2019 (COVID-19) can present with significant cardiac dysfunction, including cardiogenic shock. Mechanical circulatory support with an Impella device may be utilized in these patients to support and offload native right ventricle (RV) and left ventricle (LV) function. This systematic review aims to describe clinical indications, management, laboratory data, and outcomes in patients with severe cardiogenic shock from coronavirus disease 2019 (COVID-19) treated with an Impella device. Methods: A PRISMA-directed systematic review was performed and prospectively registered in PROSPERO. The databases accessed included PubMed/MEDLINE, Scopus, and ScienceDirect. Quality and risk of bias assessments were completed using the Joanna Briggs Institute (JBI) checklist for case reports. Results: A total of sixteen records were included in the qualitative synthesis. 8/16 (50%) of the patients were men. The average age was 39 years (SD: 14.7). The BiPella approach was recorded in 3/16 (18.75%). 4/16 (25%) individuals required renal replacement therapy (RRT). Single-device usage was observed in three cases; 2/16 (Impella CP; 12.5%), and 1/16 (Impella RP; 6.25%). Treatment of COVID-19 myocarditis included a wide range of antivirals and immunomodulators. 8/16 (50%) of cases needed ECMO support. Overall, only 2/16 (11.7%) individuals died. Conclusions: Sixteen reported individuals have received an Impella implanted with a mortality rate of 11.7%. Concurrent use of renal replacement therapy and ECMO implantation was often observed. Overall, the Impella device is an effective and safe strategy in the management of COVID-19-related cardiogenic shock. Future studies should include long-term results.

Cardiovascular Comorbidities in COVID-19: Comprehensive Analysis of Key Topics

“…Considering its importance in cardiovascular disease, a population-based study showed that higher ACE2 plasma levels are associated with a greater risk of severe cardiovascular disease [20]. COVID-19 has been found to increase the risk of cardiogenic shock [21,22], cardiac arrhythmias [23,24], acute myocardial injury [25,26] and sometimes sudden death in patients with cardiovascular disease [15,27,28], and at the same time, patients with cardiovascular disease have a higher risk of mortality due to COVID-19.…”